Apicectomy
In this section we will look at:
- What is an apicetomy?
- Why do I need an apicetomy?
- Do I need to see a specialist?
- What does the procedure involve?
- What should I expect after the procedure?
- What are the risks?
What is an apicectomy?
An apicectomy is a highly technical surgical procedure which can be used to manage a non-healing infection around the root of a root canal treated tooth.
The procedure involves:
- Cleaning out the infection within the bone
- Removing 2-3mm from the tip of the root
- Sealing the root canal with a filling to stop bacteria entering the tooth
Why do I need an apicectomy?
An apicectomy can be considered as an alternative treatment option to a re-root canal treatment or extraction where an infection fails to heal following root canal treatment.
Signs and symptoms of a non-healing infection include:
- Pain/discomfort around the tooth/gum
- Swellings and boils on the gum
- Bad taste in the mouth
- Sometimes you won't have any symptoms but your dentist will notice the infection hasn't healed when they take a dental x-ray of the tooth
Treatment is needed to prevent the infection from getting larger. This can result in the tooth becoming loose as the infection eats away the bone. As the infection spreads, it can also cause facial swelling.
In most cases, re-root canal treatment is favourable to an apicectomy as it has a higher long term success rate (83% after 4-6 years for a re-root canal treatment compared to 72% after 4-6 years for an apicectomy). In some cases, a re-root canal treatment is not the best option for the tooth and an apicectomy is preferred. For example, if:
- the tooth has had a high quality root canal treatment
- the tooth has already had re-root canal treatment which has failed
- there is a large infection around the tooth
- there is a high quality post/crown in place which doesn't have any signs of decay
Do I need to see a specialist?
Due to the complexity of treatment and the highly specialised equipment needed, an apicectomy is usually only carried out by an endodontist (root canal specialist) or oral surgeon.
What does the procedure involve?
Depending on which tooth is infected, how large the infection is and the experience of the clinician, an apicectomy can take anywhere from 30 minutes to an hour to complete.
The area being treated is very small. For this reason, a microscope is often used so the dentist can see everything much more clearly.
An apicectomy is typically carried out under local anaesthetic. This means the area of the mouth being treated will be numb but you will still be awake. Once the area is numb, the stages of the procedure are:
- Lifting the gum
A small cut is made in the gum and the gum is lifted away from the tooth/teeth. Often the gum is lifted away from the infected tooth as well as 1-2 teeth either side to make sure the dentist has good vision and access to the infected area. - Removing a small amount of bone
A dental drill is used to remove a small "window" of bone just over the tip of the root where the infection is. The dentist will remove the smallest amount of bone possible whilst still being able to access the root tip and the infected area. - Cleaning the infection
The infected tissue is removed from around the root and bone. Sometimes the dentist will take a bit of this tissue to send to the lab for a formal diagnosis. - Preparing the root tip
2-3mm of the tip of the root is removed as well as a further 2-3mm of the existing root canal filling. - Sealing the root
A special "filling" material (usually MTA, a biocompatible* cement-like material) is used to seal the tip of the root where the existing root filling was removed.
*biocompatible means the material is not harmful to our bodies - X-ray
Your dentist may take an xray to make sure the tooth is properly sealed before stitching the gum back in place. - Replacing the gum
The gum is put back in its original position and held in place with stitches. Some dentists use dissolvable stitches which will disappear by themselves within 14 days. Others will use non-resorbable stitches which will need to be removed approximately 7-10 days after the procedure.
What should I expect after the procedure?
You will be numb for 2-3 hours after the procedure due to the local anaesthetic. When this starts to wear off, you are likely to feel some discomfort which you can control with over-the-counter painkillers.
Many people suffer from swelling which usually appears in the day or two after the procedure. This can be both inside and outside the mouth.
The discomfort and swelling may take a couple of weeks to completely resolve.
It is important to keep the mouth clean to reduce the risk of infection. It can be difficult to clean with a toothbrush if the area is very sore so it is recommended you carry out regular salt water or chlorhexidine (Corsodyl) mouthwash. This should be started the day after the procedure.
If the area starts to bleed, you should put pressure on the area for 15 minutes with a rolled up clean handkerchief or cotton gauze (usually given by the dentist). If the bleeding doesn't stop, you should contact your dental surgery.
What are the risks?
As the gum has to be cut and lifted away from the teeth to perform the procedure, a scar can form. The gums can also shrink back away from the tooth causing the root to become exposed. This may lead to sensitivity to hot/cold. The teeth may look a bit longer but it usually isn't noticeable as the lip covers this part of the tooth.
The success rate of an apicectomy after 4-6 years is just over 70%. This means 30% of apicectomies fail after 4-6 years. If the infection returns, it may be possible to have a repeat apicectomy; but in most cases, an extraction is recommended.