What is an Apicoectomy?
An Apicoectomy is a last resort procedure that can be recommended by a dentist when a root canal surgery fails. Often times the bottom tip of the root can hold a small amount of pulp that cannot be removed during a typical root canal procedure. If this remaining pulp becomes infected as a result of the procedure, then the entire tip of the root is removed. This process is what we call an Apicoectomy. The procedure is not considered very invasive by most dentists and is certainly an easier procedure than an extraction.
Before Surgery:
A consultation with your dentist, usually after an evaluation of a failed root canal surgery, will be scheduled. The procedure will be explained to you and you will decide whether or not you want the surgery or just want to have the tooth extracted all together. You will have to decide exactly who is going to be doing the surgery. Most regular dentists are qualified to perform an Apicoectomy, but some people may feel more comfortable going to a specialist.
Your dentist might take a few X-rays after the discussion in order to plan out exactly how the surgery will be done. Previous medical records may also be consulted before surgery. Often times certain diseases or genetic disorders may have to go into planning out the surgery.
The Surgery:
Step 1: The gum is cut away using a small tool with a sharp blade on the end of it. The dentist or surgeon must cut away just enough of the gum to expose the infected root.
Step 2: The tip of the root is measured and marked according to the results in the X-ray. The tip is then cut off at this point, removing the infected pulp and also some of the bone.
Step 3: The bottom of the tooth is covered with a dye. In case cracking or other damage is caused by the surgery, the dye will highlight any small crevices in the tooth. If the surgery results in a large amount of damage, then the tooth will likely be extracted and the Apicoectomy will not continue.
Step 4: The newly exposed tip of the root will now be cleaned and filled with a sealant of some sort. In order to ensure that the tip is as clean as possible, the dentist will often use a special microscope to look at it.
All tooth surgery procedures will involve an anesthetic of some kind. The Apicoectomy procedure will often call for an unusually strong anesthetic.
Healing:
The area which has been worked on will often times be very swollen for a short period of time. It is recommended that you place an Ice Pack on the area. Although you may be tempted to rub or rinse out the location at which the surgery was performed, it is best left alone. Medication to numb the pain after surgery may also be prescribed.
Pain and swelling may last up to a week. Any stitches put into place will most likely be removed in a couple of days. You can ask your dentist about self-dissolving stitches. These will not have to be removed in a follow-up visit and will simply dissolve in your mouth after about a week.
Risks:
An Apicoectomy can sometimes have certain risks. You should talk to your dentist about them before having the surgery. Sometimes the tip of the root may be near a main nerve in the jaw. Problems may arise if the surgery results in interfering with the nerve. An X-ray can be taken to evaluate the situation.
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I have had an apicoectomy almost three months ago. It still flairs up, then it goes away. On and off antibiotics now for three months also. Now it looks like a pimple on the gum over the site and it is draining pus. How long does this go on? It is frustrating to say the least, with no dental insurance, now I am thinking I may have to have it pulled, then a bridge.