Apicoectomy

Apicoectomy Definition

It is a surgical procedure in which the tip of the root of the tooth is removed. It comes from the word “apico” meaning end or apex and “ectomy” meaning removal.

This special procedure is performed by an endodontist, someone who specializes in diagnosing and treating tooth pain secondary to root canal disease. The other term for apicoectomy is root-end resection.

The teeth consist of roots and are anchored in the jawbone. During the root canal procedure, the infected tooth is cleaned. However, there are instances when debris and infection still persist after a root canal procedure. If not addressed right away, the infection could spread to the surrounding structures.

To get rid of the infection, an apicoectomy procedure is performed. The tip of the tooth is removed along with the infection. To prevent the infection from coming back, a sealant is placed. ^{(1, 2, 3, 4)}

Image 1: The figure shows a root-end resection procedure or popularly known as apicoectomy.
Photo Source: c2-preview.prosites.com

Picture 2: An actual image of a patient undergoing apicoectomy procedure.
Image Source: i.ytimg.com

Photo 3: Cleansing and closing of the tooth’s canal.
Picture Source: 1.bp.blogspot.com

How is apicoectomy done?

Prior to the procedure, a consultation is made. If you are a candidate for an apicoectomy, you will need to meet an endodontist, a dentist who has two years of extra education in certain dental procedures like root canal and apicoectomy.

Before the surgical procedure, an x-ray of the tooth and the surrounding structure is obtained.

1. There will be ongoing inflammation and so the dentist will put you on antibiotics and anti-inflammatory drugs to significantly reduce the inflammation.
2. A small incision in the gum is made to lift the gum away from the tooth and bone. To access the root, the dentist will be needing a drill. Together with the infected tissue, the last millimeters of the tip of the root is removed.
3. Once successfully removed, the doctor will clean and seal the end of the tooth’s canal. Before stitching the tissue back in place, a final x-ray of the tooth is obtained.
4. The entire apicoectomy procedure usually lasts for about 60 to 90 minutes. The duration primarily depends on the location of the tooth as well as the nature of the patient’s condition. The more complex the root structure is, the longer the procedure will be. ^{(3, 5, 6, 7)}

Apicoectomy recovery

If everything turns out well, the patient will fully recover in a week or two. There are special instructions that a patient should strictly follow after apicoectomy to hasten the recovery period. This includes the following:

• The patient should be put on a soft diet.
• Apply cold compress on the surgical site 12 hours post procedure.
• Do not brush the teeth post apicoectomy.
• Be very gentle when rinsing the mouth post procedure.
• Swelling and pain are normal in the first few days post apicoectomy. Swelling and pain are temporary and can be relieved using pain reliever and anti-inflammatory drugs.
• Do not smoke or eat hard foods post apicoectomy.
• Avoid talking too much as the movement of the lips can loosen the stitches and can alter the healing process.
• The stitches will be removed 4 to 7 days after apicoectomy. After two weeks, the swelling and pain will completely go away. ^{(8, 9, 10)}

Apicoectomy complications and risks

There is a possibility that the surgery may not work and that the affected tooth will be extracted. The location of the tooth has something to do with the overall success rate of the procedure. A tooth located at the back of the upper jaw may involve the sinuses.

There are plenty of nerves near the roots of the back teeth. During the surgery, there might be a possibility of nerve damage. To lessen the risk, the doctor will order an x-ray of the tooth to check the proximity of the roots to the nerves. ^{(2, 5, 8, 10)}

What is the success rate of an Apicoectomy?

Apicoectomy has a high success rate. About 80% to 90% of people who underwent apicoectomy were extremely satisfied with the outcome. ^{(2, 5)}

Why should you undergo an apicoectomy?

The primary purpose of apicoectomy is to get rid of the infection and preserve the function of the tooth and spare it from extraction. It should only be performed if the prior root canal procedure failed. Reasons for apicoectomy are as follows:

• Blockage in the root canal – There is a possibility that the dentist didn’t thoroughly clean the root canal due to blockage such as a fractured file from prior root canal treatment. The remaining debris and infection can significantly affect the adjacent teeth.
• Tiny root branches of the tooth joined together – The tooth contains roots with tiny branches on them. During the root canal procedure, these small branches should be thoroughly cleaned and sealed. If the root canal procedure is not done right, inflammation could persist. Which is why an apicoectomy procedure is necessary.
• Poorly shaped root canal – If the root canal is not properly shaped (narrow or curved), it would be impossible for the endodontic file to reach the tip of the roots. This simply means that there is a possibility of another infection.
• Persistent symptoms – If pain and inflammation still persist post root canal procedure, then an apicoectomy will be necessary.
• For better visualization – There are instances when the tip of the root and other structures in the periradicular area cannot be thoroughly visualized, which makes sealant application difficult. For this reason, the dentist feels that it might be better to do an apicoectomy than a root canal. ^{(2, 4, 7, 9)}

How much does it cost for an Apicoectomy?

There are various factors that could affect the cost of apicoectomy procedure. These include the position of the tooth, the qualifications of the dentist, and the local rates.

The necessary follow-up treatment will be included in the total cost of apicoectomy procedure. The cost of the entire procedure ranges from $900 to $1,300 without dental insurance. ^{(2, 3, 5)}

What could be the reason for apicoectomy failure?

There is about 10% to 20% failure rate. The possible reasons are as follows:

• The tooth is not properly or thoroughly sealed (failed coronal seal).
• Reinfection caused by poor apical sealing.
• The patient is not an ideal candidate for an apicoectomy. ^{(1, 6, 9)}

References:

1. http://dentalcarematters.com/apicoectomy/
2. https://en.wikipedia.org/wiki/Apicoectomy
3. https://www.colgate.com/en-us/oral-health/procedures/root-canals/apicoectomy
4. http://www.deardoctor.com/inside-the-magazine/issue-29/apicoectomy/
5. https://www.slideshare.net/khizer7syed/apicoectomy
6. http://www.rvomfs.com/procedures/oral-maxillofacial-surgery/apicoectomy/
7. http://www.arootcanalspecialist.com/?page_id=193
8. https://www.dentalguide.co.uk/patient-guides/a-guide-to-apicoectomy/
9. https://www.1800dentist.com/apicoectomy/
10. https://charlestonendodontics.com/2017/06/20/saving-teeth-apicoectomy/