Page 14 - Journal of Laser Dentistry 1

Apicoectomy

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 or end of each root is called the apex. Nerves and blood vessels enter the tooth through the apex. They travel through a canal inside the root, and into the pulp chamber. This chamber is inside the crown (the part of the tooth you can see in the mouth).

During root canal treatment, the canals are cleaned. Inflamed or infected tissue is removed. An apicoectomy may be needed when an infection develops or won't go away after root canal treatment or retreatment.

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. This can 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 it is often done using an operating microscope.

If a root canal procedure has been done in the past and it becomes infected again, it's often because of a problem near the apex of the root. In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect other canals that were not adequately treated. In this case, they may be able to clear up the infection by doing a second root canal procedure. This will avoid the need for an apicoectomy.

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 and retreatment has not been successful or is not possible. For example, retreatment is often not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Before the procedure, you will have a consultation with your dentist. Your general dentist can do an apicoectomy. However, with the advances in endodontic microsurgery, it is best to be referred to an endodontist. Apicoectomies also are done by oral surgeons.

Before the surgery, your dentist may take more X-rays of the tooth and surrounding bone. You may be given an antimicrobial mouth rinse, a medicine to reduce inflammation, and/or antibiotics.

Your dentist also will review your medical history. Depending on other existing medical conditions, your dentist may consult with your physician before the procedure.

The endodontist will cut and lift the gum away from the tooth to gain access to the root. The infected tissue will be removed along with the last few millimeters of the root tip. The endodontist will use a dye to highlight cracks and breaks in the tooth. If the tooth has large cracks or breaks, it may have to be extracted. In this case, the apicoectomy will not continue.