What is an Apicoectomy and Who Needs One?

When a root canal fails, your dentist may recommend an apicoectomy. During this minor surgical procedure, the oral surgeon removes the tip of the tooth’s root. The root canal is then sealed to prevent further infection and damage to the surrounding bone and tissue.

Ideally, apicoectomy will help the surrounding bone heal. This can save your teeth from further damage, allowing you to possibly save your tooth for years to come. 

As not every tooth is a candidate for apicoectomy, here is a list of the most common reasons why someone may need to have an apicoectomy:

5 Reasons to Get an Apicoectomy

Dentists will typically recommend a root canal before an apicoectomy procedure. But in some cases, a root canal doesn’t fix the pain or the infection surrounding your tooth. In this situations your dentist may refer you to an oral surgeon because:

  1. You are experiencing tooth pain that doesn’t go away after root canal treatments
  2. You have calcium deposits make a root canal implausible
  3. You have a tooth that gets re-infected years after a root canal
  4. There is damage to the root surface of a tooth or surrounding bone
  5. Inflammation and infection persist directly after a root canal

Here are the symptoms to look out for that may mean you need an apicoectomy:

Signs You Need an Apicoectomy

The first sign that you might need an apicoectomy is tooth pain. When the pulp of your tooth gets infected or inflamed due to trauma or aging, the pulp may die. This causes a severe toothache, jaw pain, and even swelling. 

If you experience any of these symptoms, go first to your dentist as a root canal is the first line of defense. But if your dentist deems the issue too severe, they’ll refer you to an oral surgeon for an apicoectomy.

How Does Apicoectomy Work?

We understand your anxiety, and we want to ease it by walking you through the 3 phases of apicoectomy: the pre-operative imaging phase, the surgery itself, and the post-operative care phase. Here is what to expect from the procedure.

The Imaging Phase

The first thing an oral surgeon will do is diagnose the problem. This requires imaging of the infected or decaying tooth. X-rays or cone beam-computed tomography (CBCT) scans are most common for diagnosing teeth in need of surgery. These scans will give the oral surgeon  a 3D view of your teeth, allowing them to identify fractures, cysts and other damages to the root of the tooth. 

Surgical Technique

After diagnosing the issue with scans, you’ll come back for the surgery itself. At this point the oral surgeon will discuss the possibility of using IV-sedation vs local anesthesia for your upcoming procedure. 

The oral surgeon makes a small cut in the gum under which the infected root is located. The root is cleaned of inflamed and infected tissue before the tip of the root canal is removed.

After excising the infected tissue and root tip, your oral surgeon will fill the root canal. This is a tiny filling meant to help the gums heal correctly. Because now that the infection is cleared out, the tissue will have time to mend itself.

Some cases may require bone grafting. Grafts are meant for cases in which the surrounding bone is significantly damaged to the point that it needs to regrow for ideal tooth and gum health.

After the Surgery

Apicoectomies are surprisingly quick and comfortable. Oral surgeons use state-of-the-art techniques and tools to ensure it. What’s more, apicoectomy is successful in up to 90% of cases.

However, the outcome of your surgery often depends on how well you follow your oral surgeon’s after-surgery care instructions.

Alternatives to Apicoectomies

Once you get to the point of needing an apicoectomy, there aren’t many alternatives to consider. For those who either can’t undergo the procedure or fear surgery, you could opt for a second (retreat) root canal. This works best when your dentist spots the reoccurring infection early on. The second root canal can easily clean up the infection without having to turn to surgical techniques.

But if the reoccurring infection is far along, there’s usually no alternative to apicoectomy other than extraction.