Strong roots that extend into the jawbone hold the teeth firmly in place. Premolars and molars tend to possess many roots, whereas the incisors possess only a single root. The tip or end of each root is known as apex. Blood vessels and nerves enter the tooth through the apex. In other words, the apex aids in the supply of blood to the crown (the visible portion of the tooth in your mouth).
A root canal therapy is the removal of inflamed and infected tissue in the root and the cleaning of the canals. If the infection or inflammation persists after the root canal treatment, there may be the need for an apicoectomy. An apicoectomy simply refers to removing the apex and filling the root to prevent further infection. Infected roots, when not treated, can cause damage to other teeth, trigger the spread of infection, and lead to regression of the jawbone.
Reasons for an apicoectomy
Inflamed and infected tissue at the root of a tooth can be extremely debilitating and painful. An apicoectomy effectively helps to get rid of infection in the tissue, preserving and saving the tooth from extraction. The surgeon will likely not consider an apicoectomy unless there’s a prior root canal therapy that has failed.
Some of the reasons why an apicoectomy may be required include:
- Small Adjoining Root Branches – roots are very complex and usually have lots small branches. Inflammation can persist if these branches are not properly cleaned and sealed during the root canal treatment.
- Blocked Root Canal – sometimes, the surgeon is not able to properly clean a root canal because a fractured fragment from a previous root canal treatment has blocked it. Adjacent teeth can quickly be affected by debris and infection.
- Curved or Narrow Root Canals – a poorly shaped root canal will prevent the endodontic files from reaching the root tip. This can lead to the occurrence of re-infection or continuing infection
What does getting an apicoectomy involve?
Before the surgery, the surgeon prescribes an anti-inflammatory or antibiotic medication to treat any underlying infection. Panoramic X-rays are then taken to help the surgeon in planning the apicoectomy, which is carried out under local anesthesia.
The surgeon makes an incision in the gum and reveals the root by lifting the gum. Sometimes, he removes a small part of the jawbone to reveal the root. Ultrasonic instruments are then used to remove the edge of the root tip as well as any infected connective tissue. A filling material known as retrofill is then used to seal the root, and the surgeon uses several stitches to suture the gum.
This surgery doesn’t require that the patient stay overnight, and full pain medications and aftercare instructions will be provided. After some days, the stitches will be removed by the surgeon. The connective tissues will also be fully healed after several months.
If you are experiencing symptoms, such as swelling or pain in a tooth that has had a root canal therapy, you are encouraged to visit our office right away.