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Apicoectomy: Another Option Available When Original Root Canal Treatment Fails

A picture of the patient's perspective as the dentist brings the overhead light up close.
When conventional root canal treatment fails or is not a practical option, your dentist may recommend apicoectomy—a surgical procedure that involves going through the gum to remove the infected tissue surrounding the root tip (apex). If your tooth has had one or more root canal procedures, dentists perform apicoectomies as another attempt to save the tooth.​

Why Apicoectomy May Be Necessary

Root canals sometimes become re-infected. When that happens, your dentist or endodontist may decide to treat the infection by removing the tip of the tooth root and the affected tissue surrounding it. Causes of persistent or recurring infection include:
  • Infection that spreads into the bone and tissues in the area near the tip of the root
  • New tooth decay on the root of the tooth
  • Infected debris in the small branches at the sides of the main root canal
  • Narrowing of canals due to aging, which makes adequate cleaning of the canal difficult
  • Cracked or fractured tooth root
In some cases, a cracked or fractured tooth root may be too damaged to repair; therefore, the tooth cannot be saved and you need to have the tooth extracted.

How Dentists Detect Root Canal Problems 

A dentist uses x-rays and CBCT scans (cone beam-computed tomography) to examine tooth roots. CBCT scans create three-dimensional views that allow the dentist to see problems that might otherwise be difficult to detect.
The tooth root, which comprises the lower two-thirds of the tooth, is covered by a thin layer of bone-like material called cementum. Damage to that protective layer can lead to problems. But since the root fastens the tooth in the jawbone, it can't be seen without x-rays or other digital imaging studies.

How Apicoectomy Is Performed 

Instead of accessing the pulp chamber and canals through the crown of the tooth—the part of the tooth that sits above the gumline—a dentist who specializes in treating root canal disease makes a small incision through the gum at the site of the infection. This is often a better alternative to removing the crown from previous root canal treatment—a move that can weaken the tooth more.
If infection is severe, bone grafting may be necessary to help replace bone loss around the tip of the root. A graft helps stimulate new bone to grow in the affected area. The endodontist may take the bone for the graft from your jaw.

What to Expect Before and During Surgery 

Depending on the severity of the infection, your dentist may prescribe anti-inflammatory medication or antibiotics before the day of surgery to help fight the infection. When you arrive at the dental office for surgery, the dentist will numb the area with local anesthesia before making the incision. Cutting away the gum tissue makes it easier to get to the tooth root.
After removing inflamed or infected tissue and a bit of the root tip, your dentist will seal the canal with a small filling to prevent further infection. The gum tissues are then stitched closed so that healing can begin. It takes a few months, but the bone around the end of the root eventually heals.

What to Expect After Surgery

Your dentist may recommend taking an over-the-counter nonsteroidal anti-inflammatory drug to manage any sensitivity, soreness, or pain you experience following the surgery. Since the area may bruise and swell, applying an ice pack to the outside of your cheek helps reduce pain and swelling.
Avoid smoking, biting into crunchy foods or foods that are hard to chew, or vigorously brushing the teeth adjacent to the treated area until healing begins. Otherwise, you might loosen the stitches or dislodge the blood clot, either of which can delay healing.
Let your dentist know if you suffer numbness in the area for more than a few days. Although rare, there is the risk of nerve damage, especially if the procedure was performed on a back tooth in the lower jaw. Although dentists use operating microscopes that allow them to see better when performing this type of endodontic surgery, it still is possible to hit a nerve located near the treated site.
If you've had recent root canal treatment, but the tooth continues to show signs of infection or post-surgical complications, the professional staff at Gregg Dentistry can explain alternative treatment options for you to consider.