Page 15 - Journal of Laser Dentistry 1

To complete the apicoectomy, the endodontist will clean and seal the end of the tooth's canal. The cleaning usually is done under a special microscope using ultrasonic instruments. The light and magnification allow the endodontist to see the area clearly. This increases the chance that the procedure will succeed. The endodontist then will take an X-ray of the area before stitching the tissue back in place.

Most apicoectomies take 30 to 90 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Your endodontist will tell you which medicines to take and what you can eat or drink. You should apply ice to the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others). In some cases, you may be given a prescription medicine.

To allow for healing, you should avoid brushing the area or rinsing vigorously. Also, don't smoke or eat crunchy or hard foods. Do not lift your lip to examine the area. This can loosen the stitches and disrupt formation of a blood clot that is needed for healing.

You may have some numbness in the area for days or weeks after the surgery. Tell your dentist about any numbness. The numbness usually goes away with time.

Your stitches will be removed 2 to 7 days after the procedure. All soreness and swelling are usually gone within 14 days.

Even though an apicoectomy is considered surgery, many people say that recovering from it is easier than recovering from the original root canal treatment.

The endodontist will review the risks of the procedure at the consultation visit. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses. Your dentist may suggest antibiotics and decongestants.

The roots of the back teeth in the lower jaw are close to some major nerves. Surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution. It should last for the life of the tooth.

If you're having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist. Sometimes after a root canal a pimple develops near the tooth. This pimple will often go away and then come back. This is called a fistula. The fistula is a sign that there is an infection and your body is draining it out through the pimple. There is usually no pain in this situation.

If you have symptoms, such as pain or a fistula, contact your dentist. He or she will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.