Apicoectomy

Apicoectomy also known as, root end surgery is an endodontic surgical procedure whereby a tooth's root tip is removed and a root end cavity is prepared and filled with a biocompatible material.This is usually necessitated when a conventional root canal therapy had failed and a re-treatment was already unsuccessful or is not advised. State-of-the-art procedures make use of microsurgical techniques, such as a dental operating microscope, micro instruments, ultrasonic preparation tips and calcium-silicate based filling materials. Oral and Maxillofacial Surgeons perform this procedure at Delhi Dental Hub.

When is an Apicoectomy needed?
Apicoectomy is a surgical procedure usually performed only after a failed root canal treatment. The majority of failed non surgical root canals are caused by problems near the tip (apex) of the root. Apicoectomy is an invasive but effective surgical procedure to overcome this kind of problems.If the nature of the problems that caused the root canal complications indicates that a re-treatment will not be successful, an apicoectomy is the only solution. Apicoectomy is needed if an infection develops or persists after root canal treatment or re-treatment (failed root canal). Conditions that require an apicoectomy include:
1) An uncleaned root canal blocked by a fractured file that cannot be removed.
2) A fracture or crack on the tooth roots.
3) A badly curved root canal obstructing endodontic files from reaching the root tip.
4) Several small branches at the sides of the root canal that can not be cleaned and sealed.
5) Other conditions that obstruct healing after a root canal treatment.

Apicoectomy Surgery Procedure
Before the procedure, the dentist will usually prescribe anti-inflammatory medication and/or antibiotics. X-rays of the problem area are needed for the dentist to plan correctly the step by step procedure :
Step 1 :- The area is numbed with a strong dose of a local anesthetic.
Step 2 :- The dentist will first cut the gum and lift it away from the tooth so that the root is easily accessible. Some of the jaw bone around the root may also have to be removed to expose the root tip.
Step 3 :- The edge of the root tip up to the problem area is removed, along with any infected surrounding tissues (connective tissue or/and jaw bone). If needed, the final 3-4 mm of the root canal are cleaned using ultrasonic instruments and filled with a biocompatible material. This type of filling that is placed at the end of the root is called a retrofill.
Step 4 :- Finally the gum tissue is placed back in place over the root and sutured.

The duration of the procedure depends on the type of tooth involved and may be from 30 to 90 minutes.Normally after a successful apicoectomy any signs of infection will disappear and the bone tissue around the root tip will heal within a few months. An infection that persists after the surgery is indicating an apicoectomy that failed.

Prognosis (Apicoectomy success rate ?)
Follow up clinical examinations and x-rays are necessary to confirm the success of an apicoectomy procedure. The apicoectomy may be the last chance for a tooth to avoid extraction.Apicoectomy success rate is high if performed by a skilled endodontist, but as in all surgery procedures there is always a risk of complications and failure. Possible apicoectomy complications are similar to those of the initial root canal treatment. In case of a failed apicoectomy, the tooth will have to be extracted.

Apicoectomy surgery recovery time and after care
While apicoectomies are considered as surgical procedures they cause minor discomfort. Apicoectomy recovery is usually quick and without complications. Some soreness, swelling and pain are absolutely normal after the apicoectomy surgery. Sutures are removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Some useful instructions to relieve any discomfort, help healing and minimize apicoectomy recovery time are:
1) To minimize any swelling, place ice packs to the side of the face where surgery was performed, for 12 hours.
2) Follow your dentist’s instructions regarding any medications prescribed (anti-inflammatory, antibiotics or pain killers)
3) To allow faster healing avoid brushing the area, vigorous mouth rinsing or eating crunchy or hard foods.
4) Reduce physical activity and rest after the procedure. No smoking for at least 2 days.
5) Avoid touching the wound area following surgery.
6) Good oral hygiene is essential to proper healing of any oral surgery site.
In most cases, the apicoectomy recovery time will not exceed two weeks. Any sign of remaining infection after this period indicates a failed apicoectomy.