What is an apicectomy?

Each individual tooth in your mouth is anchored into your jawbone by roots. The number of roots present depends on which tooth it is – the front teeth tend to have one root holding them in position, whereas the teeth further back, known as the molars and premolars, have at least two roots. The roots have an area called the apex located at the end. The apex is the place where the blood vessel and nerves go into the tooth. Such nerves manoeuvre through the root canal and into the chamber in the crown of the tooth. Sometimes, these root canals can become infected or inflamed and require root canal treatment.

Sometimes root canal treatment can fail to remove the infection if it is lodged in smaller nerve branches as opposed to just the main ones. This subsequently leads to the need for an apicectomy. In the apicectomy procedure, either the root tip is removed or the apex is. This area is then substituted with a filling to ensure that the root ending is completely coated and sealed. This treatment procedure is often performed using an operating microscope and are therefore commonly known as endodontic microsurgery.

What would result in the need for an apicectomy?

At present, thanks to major technological advances, apicectomy are no longer the first procedure resorted to if root canal treatment fails. These days, dentists can locate the canals that were not thoroughly treated in the first root canal procedure. The dentist can then use this knowledge to aim root canal treatment at more specific locations. If this can be done successfully, there is no need for an apicectomy.

You tend to require an apicectomy to solve an issue that will prevent the need for tooth extraction. A dentist performs the procedure if two root canal processes harbour the undesired results or if a second root canal treatment is not possible. The latter may be the case if the tooth in question has got a bridge or a crown on it as it would be damaged or destroyed in the process. If this is the case, an apicectomy would be considered to remove the root tip as opposed to the entire tooth's root.

The apicectomy procedure

Prior to the actual apicectomy, you will be required to attend a consultation with the dentist, endodontist or oral surgeon who will perform your treatment. Throughout this consultation, you will learn about the procedure and exactly what it entails. It is often considered best to have the apicectomy under the hand of an experienced endodontist due to the increased and better use of endodontic microsurgery. During this meeting you will be questioned on your dental and medical history and it is vital that you tell the dentist everything.

Also before the apicectomy, you will have a number of X-rays taken of the tooth that requires treatment as well as the bone and tissue that surrounds it. This just increases the knowledge of the precise location of treatment. After this, your medical professional will provide you with an antibacterial mouthwash, antibiotics as well as certain medications that can limit the amount of inflammation.

During the actual apicectomy procedure, the endodontist will remove the gum that surrounds the tooth. This is done so the roots can be accessed with ease. This allows the endodontist to be able to extract any infected tissue. This process involves the root canals being cleaned using ultrasonic instruments very accurately due to the use of a specialised microscope. Then the endodontist will cut off the tip of the root – this is usually just a couple of millimetres – and the tissue is stitched back into position as seen by the X-rays.

The whole apicectomy procedure tends to last anywhere between half an hour to an hour and a half. The exact length of time varies due to how complex the root structure is as well as which tooth is requiring the treatment. Generally speaking, teeth at the front of the mouth do not take as long to treat as the premolars and molars further to the back of the mouth take a while longer.

Apicectomy risks

A primary risk of an apicectomy is simply that it will be unsuccessful. In such circumstances, your tooth may require removal. Other potential risks are associated with where the tooth is located in the mouth. Treatment on those that are found in your upper jaw near the back may have a negative impact on your sinuses. To try and prevent infections or other problems of the sinuses, the dental professional may prescribe decongestants and/or antibiotics. Alternatively, apicectomies performed on the lower jaw's back teeth carry a risk of nerve damage due to here being the location of major nerves. To minimise this hazard, the X-rays taken during the consultation can be analysed and the nerves are located precisely so the endodentist is aware of which areas the nerves are in to avoid.

If you suffer from a level of swelling or pain in the location what you underwent treatment, then you must contact the individual who performed the treatment immediately. Another time you should approach the dental professional is in cases where small pimples appear around the tooth that had treatment. These pimples are caused fistulas and are a sign of infection. If you tell your endodontist, they can drain the fistula.

Milan Tomic

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