| What Is It?
Your teeth are held in place by roots that extend into your jawbone. Front
teeth usually have one root. Other teeth, such as your premolars and molars,
have two or more roots. The tip of each root is called the apex. Nerves and
blood vessels enter the tooth through the apex, travel through a canal inside
the root, and into the pulp chamber, which is inside the crown (the part of
the tooth visible in the mouth).
An apicoectomy may be needed when an infection develops or persists
after root
canal treatment,or retreatment. During root canal treatment, the
canals are cleaned, and inflamed or infected tissue is removed. Root
canals are very complex, with many small branches off the main canal.
Sometimes, even after root canal treatment, infected debris can remain
in these branches and possibly prevent healing or cause re-infection
later. In an apicoectomy, the root tip, or apex, is removed along with
the infected tissue. A filling is then placed to seal the end of the
root.
An apicoectomy is sometimes called endodontic microsurgery because the
procedure is done under an operating microscope.
What It's Used For
If a root canal becomes infected again after a root canal has been done,
it's often because of a problem near the apex of the root. Your dentist
can do an apicoectomy to fix the problem so the tooth doesn't need to
be extracted. An apicoectomy is done only after a tooth has had at least
one root canal procedure.
In many cases, a second root canal treatment is considered before an
apicoectomy. With advances in technology, dentists often can detect additional
canals that were not adequately treated and can clear up the infection
by doing a second root canal procedure, thus avoiding the need for an
apicoectomy.
An apicoectomy is not the same as a root resection. In a root resection,
an entire root is removed, rather than just the tip.
Preparation
Before the procedure, you will have a consultation with your dentist.
Your general dentist can do the apicoectomy, but, with the advances in
endodontic microsurgery, it is best to be referred to an endodontist.
Your dentist may take X-raysand
you may be given an antimicrobial mouth rinse, anti-inflammatory medication
and/or antibiotics before the surgery.
If you have high blood pressure or know that you have problems with
the epinephrine in local anesthetics, let your dentist know at the consultation.
The local anesthetic used for an apicoectomy has about twice as much
epinephrine (similar to adrenaline) as the anesthetics used when you
get a filling. The extra epinephrine constricts your blood vessels to
reduce bleeding near the surgical site so the endodontist can see the
root. You may feel your heart rate speed up after you receive the local
anesthetic, but this will subside after a few minutes.
How It's Done
The endodontist will cut and lift the gum away from the tooth so the
root is easily accessible. The infected tissue will be removed along
with the last few millimeters of the root tip. He or she will use a dye
that highlights cracks and fractures in the tooth. If the tooth is cracked
or fractured, it may have to be extracted, and the apicoectomy will not
continue.
To complete the apicoectomy, 3 to 4 millimeters of the tooth's canal
are cleaned and sealed. The cleaning usually is done under a microscope
using ultrasonic instruments. Use of a surgical microscope increases
the chances for success because the light and magnification allow the
endodontist to see the area better. Your endodontist then will take an
X-ray of the area before suturing the tissue back in place.
Most apicoectomies take between 30 to 90 minutes, depending on the location
of the tooth and the complexity of the root structure. Procedures on
front teeth are generally the shortest. Those on lower molars generally
take the longest.
Follow-Up
You will receive instructions from your endodontist about which medications
to take and what you can eat or drink. You should ice the area for 10
to 12 hours after the surgery, and rest during that time.
The area may bruise and swell. It may be more swollen the second day
after the procedure than the first day. Any pain usually can be controlled
with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofem (Advil, Motrin and others) or prescription medication.
To allow for healing, you should avoid brushing the area, rinsing vigorously,
smoking or eating crunchy or hard foods. Do not lift your lip to examine
the area, because this can disrupt blood-clot formation and loosen the
sutures.
You may have some numbness in the area for days or weeks from the trauma
of the surgery. This does not mean that nerves have been damaged. Tell
your dentist about any numbness you experience.
Your stitches will be removed 2 to 7 days after the procedure, and all
soreness and swelling are usually gone by 14 days after the procedure.
Even though an apicoectomy is considered surgery, many people say that
recovering from an apicoectomy is easier than recovering from the original
root-canal treatment.
Risks
The endodontist will review the risks of the procedure at the consultation
appointment. The main risk is that the surgery may not work and the tooth
may need to be extracted.
Depending on where the tooth is located, there may be other risks. If
the tooth is in the back of your upper jaw, the infection can involve
your sinuses, and your dentist may suggest antibiotics and decongestants.
The roots of the back teeth in the lower jaw are close to some major
nerves, so surgery on one of these teeth carries a slight risk of nerve
damage. However, your endodontist will use your X-rays to see how close
the roots are to the nerves, and the chances of anything happening are
extremely small.
An apicoectomy is usually a permanent solution, and should last for
the life of the tooth.
When To Call a Professional
If you're having any pain or swelling from a tooth that has had root-canal
treatment, contact your dentist, who will take X-rays and do an exam.
If your dentist feels you need an apicoectomy, you will need to set up
an appointment for a consultation.
Additional Info
American Association of Endodontists
211 East Chicago Ave.
Suite 1100
Chicago, IL 60611
Phone: 312-266-7255
http://www.aae.org/
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