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 is 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.
What is the procedure for Apicectomy?
- An Xray is first taken to determine the exact position of any cystic or infected tissue.
- You will be provided with an anti-bacterial mouthwash rinse before the surgery begins.
- Your tooth will be fully numbed to ensure that the procedure is completely pain free. You may wish to have the treatment under IV sedation if you wish to be more relaxed throughout the procedure.
- The gum around the tooth in question is eased back near the apex of the tooth.
- Any Infected and cystic bony and soft tissue around the apex of the tooth is removed. This infected tissue may be sent to a pathology lab for pathological diagnosis.
- The very apical 2-3 mm of the root of the tooth is removed.
- Retrograde MTA root filling material is placed at the apex of the tooth to ensure that the apex of the root is sealed.
- If the bone loss is considerable, bone grafting material is placed in the boney cavity around the apex of the tooth to encourage bony re-growth in that region.
- The gum is sutured back together to encourage correct gum healing with resorbable sutures.
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 the apicectomy to remove any residual sutures and to check good healing has occurred.
Are there any risks associated with Apicectomy?
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.
What is the success rate with Apicectomy?
Success rate with apicectomy 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.
Who will carry out the Apicectomy?
Apicectomy is usually carried out by experienced dentists, root canal specialists or specialist oral surgeons. Our dentists have the skills and experience in performing complex surgical procedures such as Apicectomies and root canal treatments and our Specialist Oral Surgeons (Dr. Dejan Dragisic and Dr. Hassan Taqvi) are both on the General Dental Council’s specialist list for Oral Surgery.
How much does Apicectomy cost?
There is variation in the cost of Apicectomy depending on tooth complexity, severity of infection and whether bone grafting is required or not. Cost of Apicectomy ranges from £295 and £595. Your dentist will provide you with a written treatment plan and quote for the Apicectomy at your consultation visit.
To read questions and answers from experts about Apicectomy see our Cosmetic Dentistry Forum
Our Practice is open seven days a week from 8am till 11pm. You can book a free consultation with one of our experienced dentists by calling 0208 547 9997 or emailing us for further information or to arrange a consultation.