In order to better understand apicoectomy, it is helpful to learn first some things about the non surgical endodontic treatment, root canal. Root canal (resection) is required when the soft internal tissue, or “pulp” of a tooth is contaminated or gets infected. This can occur due to advanced dental caries, repeated treatments to the tooth, or to dental trauma. Through the endodontic treatment the damaged dental pulp is removed. Subsequently the root canals are cleaned, and are afterwards filled with special materials so that the tooth is protected against a possible reinfection.
However, in some very rare cases and at a rate that does not exceed 1-2% the tooth cannot be saved by endodontic treatment only. If this is the case, your dentist or endodontist may recommend an endodontic surgery, the so-called apicoectomy.
What is the apicoectomy?
In this procedure, the endodontist lifts the gums up, exposing thus the tooth which is inflamed. The endodontist removes the infected tissue and removes a tiny piece from the edge of the root.
Subsequently a quantity of special material is placed on the edge of the root so that it gets filled. This material does not only fill the edge of the root hermetically so that there is no reinfection of the root canal, but has also the capacity of stimulating the cells of the body so that the bone that has been destroyed is formed again. This material is completely biocompatible and extensive research has taken place regarding its complete integration in the tooth, the gums and the bone. There is no possibility that allergies occur, or that the material is rejected by the body. It is used in Dentistry for more than 20 years with excellent results and is the material of choice for apicoectomy operations. It is called MTA (Mineral Trioxide Aggregate) and is fully inert. After the placement of this material a few sutures are also placed in the gums, which will help in the healing of tissues.
Within a few months, the bone that lies around the edge of the root is healed.
Are there other types of endodontic surgery?
Other procedures that endodontists may perform include splitting a tooth in half (removing the root that has been damaged and cannot be healed) or even the resection of one or more roots in teeth that have multiple roots. It would be a pleasure for your endodontist to discuss with you about the type of surgical operation that is required for your teeth.
In very complex cases, it is possible that a procedure called intentional replantation is performed. In this procedure, the tooth is extracted, is healed with the use of a certain procedure out of the oral cavity and is put back in place.
The purpose of all these procedures is to save your teeth.
Who performs the endodontic surgery called apicoectomy?
All dentists that have been trained in endodontic problems and procedures at a dental school. However, due to the fact that apicoectomy may be a more demanding process than the simple non-surgical treatment, many dentists refer their patients who must undergo apicoectomy to endodontists.
What is an Endodontist?
Endodontists are dentists with three additional years of specialization in the techniques and procedures of endodontic treatment (root canal). Apart from the treatment of usual cases, they are specialized in performing complex surgical procedures. They often deal with difficult cases which they cure, such as teeth with unusual or complex root structures or small and narrow root canals. Their specialization and experience are valuable when the endodontic surgery is necessary or when there are very difficult working conditions. Thanks to their knowledge, expertise and experience they can be effective when they treat people with disabilities, people who are incapable of fully opening their mouth, older people whose teeth present particularities, people with a bad health history, or people who cannot sit in the dental chair for long. In all of the aforementioned cases speed and accuracy during the treatment are quite important, because the treatment is completed in just one session, very rapidly, and the chances of success are extremely high. This is very important in cases where the slightest inflammation in the mouth can be detrimental to the patient’s health. Such are the cases of prosthetic heart valves, kidney diseases, orthopedic prostheses and other health problems for which it is better that inflammations are avoided.
Why do I need an apicoectomy surgery?
The apicoectomy surgery can contribute to saving your tooth in various cases.
- If your symptoms insist but no problems are detected in the X-ray, it is possible that the tooth has a tiny fracture or some canal that could not be detected in the non-surgical procedure. In such a case, the surgery will allow your endodontist to examine the root of your tooth, find the problem and heal you.
- Sometimes, calcium deposits make the root canal very narrow for the tools that are used for the cleaning of teeth in the non-surgical procedure of root canal, so that we can reach the end of the root and clean and fill the root properly. If your tooth does not have the so-called calcification, your endodontist can perform a surgical operation in order to clean and fill the rest of the root canal.
- Usually, a tooth that has undergone root canal treatment (resection), will last for the rest of your life and there will never be any need of endodontic treatment. However, in certain cases, it is possible that the damage in the tooth cannot be healed. The pain in the tooth may start again, some months or even years after a successful treatment. If this is the case for you, the operation may help saving your tooth.
Although there are many surgical procedures that aim at saving your teeth, the most usual one is called apicoectomy or excision of the edge of the root. When the inflammation or the infection is still present at the bone around the edge of your tooth after a root canal treatment (resection), your endodontist may proceed to an apicoectomy.
Is this procedure of apicoectomy going to hurt?
The use of a local anesthetic makes the entire procedure completely painless for the patient. In a very small percentage of less than 5%, it is possible that you will feel in the next days a very small swelling while the incision is healing, which is something normal in every surgical procedure. The pleasing fact is the absence of pain during the surgery and after the healing of the incision.
Your endodontist will give you specific instructions that you will have to follow after the surgery. If you have any questions after the procedure, you should contact your endodontist.
Can I drive back home?
Usually there is no problem driving back home, unless the patient has other health problems. You can discuss this with your doctor.
When can I return to my normal activities?
Most of the patients return to their work as well as to their daily activities on the same day, without any problem.
Is apicoectomy covered by insurance?
Each insurance company operates in a different way. Confirm the relative information with your employer or with your insurance company before the treatment.
How can I be sure that the apicoectomy will be successful?
Your dentist or endodontist recommended the surgical operation called apicoectomy because he/she believes that it is the best for you. Of course, there is no surgical operation in the world for which one can guarantee a 100% success. The endodontist will discuss with you the chances of success, helping you make a well founded decision. The success rate at the hands of an experienced Endodontist is over 95%.
Tooth extraction or apicoectomy?
One must know that if a tooth is extracted it must be replaced by an implant, a bridge or a partial denture, so that the mouth function is restored and the displacement of the adjacent teeth is prevented. Due to the fact that these techniques require surgery, or the performance of dental procedures, for example root canal treatment in the adjacent healthy teeth, the apicoectomy usually consists the most effective and cost saving choice in order to preserve your oral health.
Regardless of the effectiveness of modern methods of tooth replacement, which can be very effective, nothing is better than your own natural teeth. You have already invested in saving your tooth. The benefits of your choice regarding apicoectomy may be a healthy and functional natural tooth that will last for the rest of your life.
For this reason and without any hesitation apicoectomy consists a treatment of choice worldwide, in the rare case that the endodontic treatment was not successful and it is not possible to repeat it.
Constantinos Laghios, Dental Surgeon-Endodontist M.S.
A tooth where its extraction and an implant placement was suggested, due to the existence of a big cyst and a previous unsuccessful apicectomy.
The apicectomy was redone:the x-ray right after the surgery
A 2-years recall: the tooth remains functional under the bridge in the mouth, and the cyst has totally disappeared with simultaneous bone remodeling.