While many surgical procedures can be performed to save a tooth, one of the most common is known as an apicoectomy, or root-end resection.
Typically, a conventional root canal is all that is required to save a tooth with injured pulp from extraction. On occasion, a conventional root canal, (a non-surgical procedure) will not be sufficient to heal the tooth, and we will recommend surgery. An apicoectomy may be your only surgical option if conventional root canal treatment fails.
It is important to note that a previous root canal treatment can become reinfected. Your teeth’s root canals are extraordinarily complex, and often have many small branches stemming off the main canal. Occasionally, after root canal treatment, infected debris can remain in these branches and prevent healing, and even cause reinfection. Again, in such cases, an apicoectomy may be the option that will save your tooth. Note: An apicoectomy is a root-end resection – not the same as a root resection. In a root resection, the entire root is removed, rather than just the tip.
What else might cause you to require an apicoectomy? You might have a canal that is inaccessible or blocked, a crack or fracture in your tooth's roots, or even an anatomical irregularity from birth.
Are you a candidate for an apicoectomy? Only a comprehensive examination can provide us with such knowledge. We will need to evaluate you carefully with an examination, a 3-D Panoramic Scan of the affected tooth and surrounding bone, and a careful review of your medical history including medications you take, (both prescription and non-prescription). We can then make specific recommendations regarding your best treatment.
There are instances where conventional root canal treatment can compromise a tooth. Example: If you have a dental implant and crown in place, the entire restoration may have to be “disassembled” to perform a root canal, which could further weaken the tooth. In such cases, an apicoectomy may be the better option, as the infection would then be treated from the “root end” of the tooth leaving the crown untouched.
An apicoectomy is typically only recommended after one or more conventional root canal treatments have been attempted – and have subsequently failed. As the infection typically occurs near the apex of the root, (tip of the root) an apicoectomy is often an effective way to treat a persistent infection.
Unlike traditional root canal treatment, an apicoectomy is a surgical procedure administered through your gums. When indicated, it is an effective procedure to remove infected tissue, and protect your affected tooth from further infection, without the need for extraction and the added expense of implants.
If you are aware of any issues in which your body does not easily fight off infection, let us know prior to surgery. In such a case you may need to take antibiotics before and after dental surgery. If you have heart problems, liver disease, diabetes, artificial joints, asthma, or take steroids for Crohn’s disease or any other condition, you must inform us as you may require additional antibiotics.
If you have high blood pressure, or know that you have problems with the epinephrine in local anesthetics, it is important you let us know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a simple filling. The additional epinephrine will constrict your blood vessels to reduce bleeding near the surgical site, which will allow us to more easily see the root. You may feel your heart rate speed up after you receive the local anesthetic. It should subside within a few minutes.
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After you receive local anesthesia, we will make a small incision in your gum tissue in the proximity of the affected root, permitting direct access to the infected root end. We will then remove any infected and inflamed tissue adjacent to the tip of your root, along with a small section (a few millimeters) of your root tip. The next step is to place a small filling at the end of your root canal to prevent further infection. We’ll then suture the incision to allow the healing to begin. Your bone will naturally heal around the root over a period of months. In some extreme cases, and especially where infection has left a significant void, bone grafting or other techniques may be employed to assist the bone in growing and filling back in. Over time, the absence of infection will allow the area to heal and return to normal function.
Note: In rare cases, if your tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.
Note: If your infected tooth is in the back of your upper jaw, please know that the infection could involve your sinuses. In such a case, antibiotics and decongestants may be indicated.
Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of your root structure. An apicoectomy is typically a permanent solution, and should last for the life of your tooth.
Following the procedure, you may experience some discomfort or slight swelling as the incision heals. While this is normal for any surgical procedure, to alleviate discomfort, an appropriate pain medication will be recommended and/or prescribed. Please visit out Infection Management page for additional, important information. If you have pain that does not respond to medication, kindly phone our office at 203 967-3707.
If you have any pain or swelling from a tooth that has had conventional root-canal treatment, kindly phone us at (203) 967-3707 to schedule a consultation. If after hours, CLICK HERE and complete our simple form.
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