At times, conventional root canal treatment is not sufficient to save your tooth and inflammation or infection persists in the bony area surrounding its root. At such times, your endodontist will recommend endodontic surgery, most often an apicoectomy, also known as root-end resection. During this procedure, the doctor opens the gum tissue near the tooth in order to be able to observe the underlying bone and remove any inflamed or infected tissue. The tip of the root is also removed. Usually, a small filling in used to seal the end of the root canal and the surgeon places a few stitches or sutures to assist in healing.
Because the endodontist will be making use of advanced surgical technology, including digital imaging and operating microscopes, he or she will be able to locate problems that were undetectable on previous X-rays and to take care of them promptly and completely.
Reasons for an Apicoectomy
There are a number of reasons that an ordinary root canal procedure may not eliminate the problem. These include: tiny fractures, hidden canals, damaged root surfaces or unhealthy bone surrounding the tooth. Essentially, an apicoectomy is designed to clean out the root area thoroughly so that complete healing can take place.
The Apicoectomy Procedure
The apicoectomy procedure is performed with the patient under local anesthetic, so there is no pain involved. You should, however, expect some discomfort or slight swelling while the incision heals — a condition typical after any surgical procedure. Your endodontist will advise you concerning which pain medication is appropriate to relieve any residual discomfort. In addition, you will be given specific aftercare directions which you follow carefully.
Typically, an apicoectomy is performed quickly and is wholly successful. Most patients experience only minimal discomfort. Though it will take several months for the bone around the end of the root to heal totally, you will probably be able to return to your normal routine the day after surgery.
Alternatives to Apicoectomy
The only alternative to apicoectomy is extraction and prosthetic replacement with a denture, dental bridge or implant. Since this alternative also involves a surgical procedure and affects adjacent teeth, endodontic surgery is considered preferable. While artificial tooth replacements have become extremely effective, it is always wise to retain you own natural tooth whenever possible.