Treatment
Apicectomy (root-end surgery) in Nuneaton
When infection persists around the tip of a root and the canal cannot be reached from inside the tooth, an apicectomy removes the infected tip and seals the root from the other end. It is a small, precise surgical procedure under local anaesthetic, and it often saves a tooth that would otherwise be lost.
When apicectomy is recommended
Most infected teeth are best treated through the crown, by root canal treatment or retreatment. Surgery is considered when that approach has failed or is not possible: when a post would have to be destroyed to remove it, when a new and well-fitting crown would be sacrificed, when a canal has calcified or is blocked by a fractured instrument, or when a cyst-like lesion at the root tip has not healed despite good treatment. It can also be the right choice when the cause of the problem is uncertain and the tissue around the root tip needs to be examined directly.
How the procedure is carried out
- Planning. X-rays from several angles, and sometimes a three-dimensional scan arranged through your dentist, map the root, the lesion and the nearby structures.
- Anaesthetic. The area is numbed with local anaesthetic. The procedure is painless, though you will be aware of pressure and the sound of the instruments.
- Access. A small flap of gum is lifted to expose the bone over the root tip, and a small window is made through the bone to reach the infected area.
- Removing the infection. The inflamed tissue and the last few millimetres of the root are removed. Under the microscope, the cut end of the root is inspected for cracks and missed canals.
- Sealing the root end. A small cavity is prepared in the root end with ultrasonic tips and filled with a biocompatible cement that encourages bone to heal against it.
- Closing. The gum is repositioned and closed with fine stitches, which are removed a few days later.
The whole procedure takes around an hour.
Recovery
Some swelling and bruising of the cheek is normal for a few days and settles with cold packs and ordinary painkillers. Stitches come out at a short review appointment. You can go back to work the next day in most cases, taking it a little easy. Healing of the bone is followed on X-rays over the following months and, usually, a year.
What to expect from the result
Modern microsurgical apicectomy, using magnification, ultrasonic root-end preparation and biocompatible filling materials, has markedly better results than the older technique, and most teeth treated this way heal well. As with any treatment, the outlook for your tooth is explained individually before you decide, together with the alternatives.