1. Getting to the Root of the Problem
Our teeth are held in place by roots attached to our jawbone. Some teeth, such as our front teeth, have only one root, while larger back teeth, such as molars, have two or more. Sometimes, these roots become so infected that an abscess forms. A small part of the tip (or apex) of this tooth must be removed, as well as any surrounding infected tissue. This procedure is called an apicoectomy, also known as endodontic microsurgery or root-end resection. A general dentist may perform an apicoectomy, but it's usually recommended to have it done by an endodontist.
2. When Root Canals Fail
Tooth roots are hollow canals through which nerves and blood vessels run from the tip to the crown (the visible part of the tooth above the gumline). Root canal surgery entails cleaning any inflamed and infected tissue from inside the crown and root canals. In the majority of cases, root canals successfully treat any ongoing problems with the tooth. However, sometimes inflammation or infection persists or returns. In that case, as an alternative to having the tooth extracted, an apicoectomy is performed.
3. A Tip for Your Endodontist
During an apicoectomy, the area will be numbed with an anesthetic containing twice as much epinephrine (a substance that reduces bleeding by constricting blood vessels) as you might get for other minor dental procedures. A portion of the gum is cut back to expose the tip of the root. The tooth is checked for cracks or fractures (if either are present, the tooth is extracted). The infected tissue and a small part of the tip of the root are removed and the canal is then cleaned and sealed with a root-end filling. The gum is then closed with dissolvable stitches.
4. Let the Healing Process Begin
Swelling and bruising following an apicoectomy are normal and should be expected. Apply ice for up to 12 hours after the surgery and rest from all normal activities. Prolonged numbness is also normal and may last for up to a few weeks. Your endodontist will warn you not to brush that area too hard or chew hard foods. Pain can be moderated with over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen. Swelling and any pain should be gone within two weeks following the procedure. The bone will heal around the root-end filling in a few months.
5. Oral Surgery Can Be Risky Business
The risks connected to an apicoectomy are uncommon, but should be considered, depending on which tooth is to be operated on. For instance, back bottom teeth are nearest to several nerves, so there is a small risk of nerve damage when an apicoectomy is performed. If the infected tooth is an upper back tooth, the infection may reach into the sinuses, requiring antibiotics and possibly decongestants. In nearly all cases, though, an apicoectomy is safe and successful.
