Apicoectomy: root canal surgery explained
An apicoectomy addresses infections after a root canal, helping to resolve issues and improve dental health.
Sometimes, inflammation or infection can stay at the root tip of a tooth, known as the apex. This can happen even after a root canal procedure or retreatment. If this occurs, you may need an apicoectomy (pronounced “ah-pee-koh-EK-toh-mee").
In this blog post, we will explain what an apicoectomy is. We will also discuss why it may be needed. Finally, we will share what to expect before, during and after the procedure.
For more information about root canals and similar procedures, visit Aspen Dental's root canal page.
What is an apicoectomy?
An apicoectomy, or root-end surgery, is a specialized dental procedure performed by endodontists to remove the tip of a tooth's root and any infected tissue. This procedure is often necessary when a standard root canal treatment has not fully resolved an infection or inflammation.
A root canal is a dental procedure aimed at removing infected or damaged pulp from the inside of a tooth, followed by cleaning, disinfecting and sealing the pulp chamber. It addresses issues within the tooth itself.
In contrast, an apicoectomy is performed when a root canal fails to eliminate infection, focusing on removing the tip of the tooth's root and surrounding infected tissue. While both procedures aim to treat dental infections, a root canal targets the interior of the tooth, whereas an apicoectomy addresses problems at the root's tip.
If you want to learn more about the root canal procedure, visit the Aspen Dental before and after page. You can find it here.
Anatomy of a tooth
Understanding the anatomy of a tooth can help demystify this process. Let’s visually break down the anatomy of a tooth to help us better understand the location of the apex (root-end).
Crown: The visible part of the tooth above the gum line, covered by enamel, which protects the underlying dentin and pulp.
Dentin: The layer beneath the enamel, which makes up the bulk of the tooth and contains tiny tubules that can transmit sensations.
Pulp: The innermost part of the tooth comprised of nerves, blood vessels and connective tissue. It plays a critical role in tooth development and sensation.
Root: The part of the tooth that extends below the gum line, anchoring the tooth in the jawbone. A substance called cementum covers the root and helps attach the tooth to the periodontal ligament.
Apex: The very tip of the root where nerves and blood vessels enter the tooth. This area is crucial because it can become infected, leading to pain and discomfort. This is the area that your endodontist will reach to perform an apicoectomy.
Why should I get an apicoectomy?
Endodontists usually need to perform an apicoectomy when an initial root canal or root canal treatment fails. If you’re still feeling pain or an infection won’t go away, it might be time for an apicoectomy. Your dentist or endodontist will be the ones to prescribe this treatment to you if need it.
Sometimes, it's necessary for things like a root fracture or when the surrounding tissue isn’t healing properly. Other reasons might include removing calcium deposits, repairing fractures or treating bone loss that loosens your teeth.
In these situations, an apicoectomy can help save your tooth and keep your smile healthy. Without root-end surgery, the only other alternative to a failed root canal procedure is tooth extraction. This will require tooth extraction surgery and possible tooth replacement solutions, like a bridge, crown or dental implants.
How root canal surgery works
Root canal surgery is a procedure designed to address persistent issues after an initial root canal treatment. Here’s what you can expect during the procedure:
1. Preparation
Before the procedure, your endodontist will talk with you. They will also take some X-rays of the area. This helps them see how bad the infection is and create a treatment plan.
2. Local anesthesia
To ensure your comfort, a local anesthetic is administered to numb the area around the affected tooth.
3. Incision and access
Next, we'll make a tiny incision in your gum near the tooth to get to the root tip and surrounding tissue.
4. Root tip and tissue removal
We’ll then remove any infected tissue and the tip of the root to tackle the source of the infection.
5. Cleaning and sealing
After the root end is removed, the area is thoroughly cleaned to remove any bacteria or debris. They then seal the site with a biocompatible material to prevent future infections.
6. Suturing and healing
Finally, the gum tissue is sutured closed to promote healing. The entire process usually takes 30 to 90 minutes.
Apicoectomy recovery
After your apicoectomy procedure, it's important to follow instructions from your doctor which will include:
Pain management
It's common to experience mild pain and discomfort post-procedure. To manage this, consider the following:
Over-the-counter pain relievers: Ibuprofen (e.g., Advil, Motrin) or acetaminophen (e.g., Tylenol) can be effective for pain management.
Follow the dosage recommendations on the package or those given by your dentist. For instance, ibuprofen can typically be taken every 6-8 hours as needed, while acetaminophen can be taken every 4-6 hours.
Diet recommendations
What you eat may affect your recovery. Here are some suggested dietary guidelines:
Soft foods: Stick to soft foods for the first few days.
Warm soups: Broth-based soups that are easy to swallow.
Smoothies: Blend fruits with non-dairy milk. Avoid using straws, as suction can disrupt healing.
Mashed potatoes: Soft and easy to eat, consider adding gravy for flavor.
Applesauce: A gentle option that’s also nutritious.
Avoid hard and crunchy foods: Stay away from chips, nuts, candies and hard fruits that could irritate the surgical site.
Oral hygiene
Maintaining oral hygiene is essential but must be done gently:
Brushing: Use a soft-bristled toothbrush to gently brush your teeth, avoiding the surgical area for the first few days.
Rinsing: After 24 hours, you can start rinsing your mouth with warm salt water (1/2 teaspoon of salt in 8 ounces of warm water) to help keep the area clean. Do this gently, about 2-3 times a day.
Lifestyle recommendations
To promote healing, consider these activity guidelines:
Rest: Take it easy for the first 24-48 hours. Avoid strenuous activities.
Avoid smoking: Smoking can hinder healing and should be avoided while your root canal surgery is healing.
Elevation: Keep your head elevated when resting or sleeping to minimize swelling.
Monitor your recovery: Most patients return to their normal activities within a few days but keep an eye on your recovery and watch for symptoms. If you notice persistent or worsening pain, excessive swelling or fever, contact your dentist immediately.
Follow-up care: Your dentist will schedule a follow-up appointment to check your healing progress and to remove your sutures once you’ve healed enough for their removal.
Taking care of yourself during this time is essential for a smooth recovery. If you have any questions or concerns, don't hesitate to reach out to your local Aspen Dental office. We’re here for you every step of the way.
Apicoectomy FAQs
How long does an apicoectomy last?
The results of an apicoectomy can last for many years. Studies indicate that almost 83% of apicoectomies have favorable outcomes even after three years. Of course, long-term success is contingent on proper oral hygiene and regular dental check-ups.
What are the risks of an apicoectomy?
While apicoectomies are generally safe, risks may include minor bleeding, infection or nerve damage. These are rare but important to consider. Discuss any concerns with your dentist prior to the procedure to address potential risks.
Is an apicoectomy painful?
Thanks to local anesthesia, this makes the procedure more comfortable. Post-operative discomfort is usually minimal and can regularly be managed with over-the-counter pain relief medications. Many patients report that any soreness subsides within a few days.
Does insurance cover an apicoectomy?
Insurance coverage for apicoectomies can vary. Many dental insurance plans cover endodontic treatments, including apicoectomies. At Aspen Dental, we accept most health insurance providers. Please note, Aspen Dental does not accept Medicaid.
Learn more about insurance and financing here >
Your path to relief
An apicoectomy is a vital procedure for those who have persistent tooth infections following a root canal. It provides a means to retain a natural tooth, avoiding more extensive dental interventions like tooth extractions.
If you're experiencing ongoing dental issues despite previous treatments, schedule an appointment to see if this procedure is right for you. For further reading and resources, visit the dental care resources at Aspen Dental to learn more.
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