In some cases a tooth that has had a root canal, which did not sufficiently heal or has become re-infected, is not a candidate for endodontic retreatment. For these teeth a minor surgical procedure that treats the infection from the root-end of the tooth, that is known as an apicoectomy, may be indicated. An apicoectomy is an excellent next step procedure to preserve a previously treated tooth, eliminate a dental infection, and to restore the health of the surrounding tissues. It is most useful in cases where fractures or hidden canals still cause pain or infection around a treated tooth, as well as when an endodontic retreatment procedure is not recommended as it will further weaken and jeopardize the tooth.
An apicoectomy may be performed under local anesthesia. It is typically a straightforward procedure during which an incision is made in the gum tissue at the involved tooth. This is to expose the inflamed or infected tissue surrounding the root tip of the tooth. Once uncovered, the damaged tissue in the area is removed along with a few millimeters of the tooth's root tip. A biocompatible filling material is then placed in the end of the remaining portion of the root to seal it and prevent any possibility of reinfection. The gum tissue flap is put back into place and sutured to complete the procedure.
Post-surgical discomfort is generally mild and you may have some swelling in the area. Most patients return to their normal activities very quickly. If needed, apply a cold compress to reduce discomfort and swelling after the procedure. The appropriate pain medication will be prescribed or recommended. If your discomfort does not respond to medication, or other symptoms that concern you develop, please call our office.
Prior to undergoing an apicoectomy the endodontist will discuss all the risks and benefits of the procedure. If during the course of an apicoectomy any significant fractures are discovered in the tooth that changes the prognosis, you will be immediately advised.