What is an Apicectomy?
An apicectomy is the removal of the tip of the root of the tooth, known as the apex to help prevent further infection of the tooth.
Why might I need an apicectomy?
This minor surgical operation is performed if infection or cysts continue to be a problem after root canal treatment or if your dentist is unable to seal the root tip with a normal root filling.
An apicectomy is usually carried out under a local anaesthetic with a dental surgeon. Apicectomy will not eliminate infection without a root canal treatment being in place first.
What happens during the apicectomy procedure?
The surgeon will make a small cut in the gum and lift it away from the tooth so the root apex of the tooth is easily accessible. The infected tissue, called granulation tissue will be removed along with a small part of the root tip.
If the tooth is cracked or fractured it my mean the tooth has to be extracted (fully removed) and the apicectomy will not work or more of the root tip may be removed.
After removing the root tip, this part of the root is then sealed with a special filling material (retrograde filling).
The gum is then replaced and sutured back together. The sutures with naturally dissolve on their own.
What to expect after the apicectomy procedure?
You can expect slight bleeding for the first 24 hours. Swelling can also be expected and reach into the tissue near the eye and discomfort may be experienced. In this case we would advise you to take an over-the-counter painkiller such as paracetamol or ibuprofen to help with this. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or dentist for advice.
What are the risks of having an apicectomy?
All surgery has risks and complications, but there are a few associated with this procedure in particular:
The procedure may not be successful, especially if the existing root filling is poor, or the tooth root is split or damaged.
You should expect the gum around the tooth to recede slightly.
You may have to have the operation repeated which can reduce the chances of keeping the tooth long-term.
With upper teeth, the infection can enter the sinus area and cause further problems.
In the lower jaw, there is a small possibility of injury to the sensory nerves. This may cause numbness or tingling of the lower lip and tongue. It may take several weeks to recover and in rare instances, the numbness may be permanent.
Is there alternative treatment to having an apicectomy?
We would not recommend leaving the infected root in place as this risks allowing infection to spread.
One alternative option would be to re-do the root filling but this then further reduces the change of the root filling being successful.
The other option would be to extract the tooth (fully remove) as this will remove the cause of the infection altogether.