Apicectomy is a minor surgical procedure where the apical part of a tooth root is removed and curettage of the tissues around the apex of the root is carried out in order to remove any infected tissue that lies around the apex of the root of the tooth.
Normally when a tooth becomes infected, root canal treatment is recommended in order to remove the infected tissue within the root of the tooth. Root canal treatment has a high success rate of around 70-90% on average. Once the root canal treatment is carried out, the source of the infection is removed and in time the infection that lies outside the root usually resolves.
Occasionally root canal treatment fails or is not sufficient by itself alone to resolve a large area of cyst or infection around the root of the tooth. In such a situation either the root canal treatment can be redone or the tooth removed or apicectomy carried out.
Apicectomy is not an alternative to first root canal treating an infected tooth and is indicated on occasions where redoing the root canal is not possible such as where a long post or a fractured instrument exists within the root canal of the tooth. Removing such a long post risks fracturing the root and removing the fractured instrument is not always possible through traditional root canal treatment. In these situations the dentist and the patient may decide that apicectomy will be a better last resort alternative to removing the tooth altogether.
The Apicectomy procedure will take around 30-90 minutes to complete depending on complexity.
As long as medically not contra-indicated a Non-Steroidal Anti-Inflammatory (NSAID) such as Iburpofen will be the best painkiller after Apicectomy as it reduces inflammation.
You may be provided with an antibiotic such as Penicillin for 5-7 days to prevent spreading infection. You may also be provided with an antibacterial mouthwash such as Chlorhexidine mouthwash for 5-7 days to prevent localized inflammation.
You will be reviewed 10-14 days after the procedure by the dentist who carried out this procedure to remove any residual sutures and to check good healing has occurred.
Like many surgical procedures, there can be some pain, bruising, swelling, tenderness, gum scarring and bleeding after Apicectomy. The tooth can become a little bit more mobile after apicectomy is carried out as it loses some root and bone support during apicectomy.
If the tooth is close to any nerves and maxillary sinus, there can be a risk of damage to these neighboring structures. Your dentist will let you know if your tooth lies close to these vital structures.
The gum around the tooth and the neighboring teeth can occasionally recede a little after apicectomy and the neighboring teeth can become a little sensitive as the result of the this gum recession.
Success rate with this treatment varies between 50-90% at ten years after the procedure is carried out depending on the severity of the infection around the root of the tooth and the number of infected canals of the tooth. If apicectomy fails it can either be redone or the tooth extracted.
If redoing root canal treatment is possible, it’s usually preferable to redo the root canal treatment rather than carry out Apicectomy as its success rate is higher. Apicectomy is usually reserved for occasions where redoing the root canal treatment is not possible.
Apicectomy is usually carried out by root canal specialists known as Specialist Endodontists or specialist oral surgeons. Our Specialists have the skills and experience in performing complex surgical procedures such as Apicectomies and root canal treatments. We also use dental microscopes to ensure we do not miss any small root anatomy.