What is an Apicoectomy?

Sometimes patients ask us, “what is an apicoectomy?”

If you’re asking about this procedure, it may be because your dental provider recommended an apicoectomy for yourself or a loved one. Perhaps you feel uneasy since you have been struggling with pain for a while. We understand, and we’re here to walk you through the procedure, recovery, and more.

Many patients who need an apicoectomy already had a root canal. During a root canal procedure, the dentist or endodontist removes infected pulp from the tooth, cleans the tooth, refills it, and reseals it. We like to think of it like a Twinkie. Imagine the cream inside is bad, so we remove the bad cream, clean it out, fill it with fresh cream, then seal it up — good as new! For most patients, a root canal is sufficient for restoring health. But some patients need to go a step further and also have an apicoectomy, which is a type of endodontic surgery.

Most of the time, an endodontist performs an apicoectomy because the patient previously had a root canal, but not all the infected tissue was removed. (In our Twinkie metaphor, a little bit of the bad cream still managed to avoid the dentist’s detection.) This isn’t intentional on the part of your dental provider if it happens to you; it’s usually because there is some kind of obstruction in the tooth that prevented them from getting all the bacteria out during the initial treatment. The apicoectomy can help complete the disinfection process, and it may prevent future infection and relieve pain.

Sometimes, the apicoectomy is the only option left to try before extracting the tooth. Whenever possible, we strive to save our patients’ natural teeth. Keeping natural teeth results in maintaining your normal smile and bite. While sometimes extractions are necessary, preserving the tooth can offer the best chance for restored health and wellbeing.

We hope this article about what is an apicoectomy answers a few of your questions. Just keep in mind that it isn’t a substitute for personalized dental care from a skilled endodontist or dentist. 

What is an Apicoectomy? When is it Needed

An apicoectomy is not the first step in treating the diseased tooth. Typically, a root canal will have already happened.

So before you can understand an apicoectomy, it is important to know that the roots of the teeth are quite complex — like a tiny tree! Your tooth’s roots have many tiny branches, and sometimes, bacteria inside the branches contribute to infection and inflammation.

If it isn’t clear exactly where the infection is within those branches, an apicoectomy may be the best option. In other cases, your endodontist may recommend another root canal. Since an apicoectomy is a more complicated procedure, be sure to choose a skilled endodontist who keeps up on best practices, such as the team at Ballantyne Endodontics.

Endodontic surgery can also be used to find and treat hidden canals that do not appear on x-rays but still result in pain or infection. An apicoectomy is one of the most common forms of endodontic surgery. 

What Happens During the Procedure

Frequently a specialist, like an endodontist, performs an apicoectomy. These professionals have extensive experience treating patients like you. Depending on which tooth needs treatment, your history, or the complexity of your tooth’s root system, your endodontist may tailor the surgery to your needs.

So let’s talk about what goes on in an apicoectomy. First, it’s important to understand that teeth are secured within the mouth by roots that extend into the jawbone. During an apicoectomy operation, your endodontist removes the tip of the tooth’s root (otherwise known as the apex). Here are the basic steps:

1. The endodontist or dental care provider will apply a local anesthetic to the treated area so you don’t experience pain.
2. Your provider will reflect the gum tissue around the tooth. It’s like making a little window to be able to access your tooth.
3. The opening exposes the bone, so the endodontist can use special state-of-the-art tools to remove the infected tissue and the tip of your tooth’s root.
4. Your provider then thoroughly cleans and reseals the root tip. The root’s end is filled and the gums are sutured in place to prevent infection.
5. Some dentists take x-rays or other imaging to ensure accuracy. The process may vary a little depending on your needs.

Once the procedure is done, 90% of the time, the bone and tissue will heal around the root. After a successful apicoectomy, the tooth’s function is restored. 

Risks Associated with an Apicoectomy

After an apicoectomy, you will most likely experience slight swelling while the incision heals, as well as some mild discomfort. This is normal.

Due to the complexity of the treatment and the fact that it is a form of minor surgery, the risks are a little higher than with a traditional root canal. These risks can be reduced by seeking care from a skilled specialist and following their pre-and post-procedure instructions.

So let’s take a look at what the risks are.

While recovering, watch for signs of complications like fever, adverse reactions to medications, increased swelling, or intense pain that doesn’t start to get better after a few days. If you are experiencing dramatic symptoms like a high fever, and it’s after business hours, visit urgent care.

For other questions, concerns, or if your pain medicine isn’t helping, call your endodontist’s office. 

Recovering From an Apicoectomy

Talk with your endodontist about the recovery process. Your provider may recommend specific anti-inflammatory medicines or your favorite over-the-counter pain medicine. Be sure to follow instructions carefully, including any required follow-up appointments. The follow-ups are to make sure you’re healing well, and everything is going smoothly.

You may experience pain and swelling for a few days or even a few weeks. This is common following any surgery, even mild surgery.

Your provider may recommend that you apply ice to the treated area a few times frequently during the first 12-hours after the procedure. This can help with the swelling.

Be sure to get plenty of rest, and treat your tooth and mouth gently. Avoid sucking on anything (like drinking through a straw), eating hard foods, or vigorously brushing your teeth while healing. Ask your endodontist for advice on how to gently keep the area clean to encourage healing. 

Next Steps if You Just Learned You May Need the treatment

We know it can be intimidating, but you’re going to be in good hands, especially if you are working with the experienced team at Ballantyne Endodontics. We have helped countless patients like yourself recover from unsuccessful or partially successful root canals through an apicoectomy or other endodontic treatment. We strive to treat the whole patient and to restore wellbeing.

If you live in the Charlotte area and need an apicoectomy, please call us for a consultation or ask your dentist for a referral.