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When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection.
Reasons for an apicoectomy
When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.
Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating to the patient.
The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction.
There are several reasons why an apicoectomy may be necessary:
- Small Adjoining Root Branches – If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
- Blocked Root Canal – In some cases, the dentist is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment.
- Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.
What does getting an apicoectomy involve?
Prior to the surgery, the dentist will generally prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection.
Panoramic x-rays will then be taken to enable the dentist to plan the apicoectomy, which will be performed under local anesthesia.
The dentist will make a small incision in the gum and expose the root by lifting away the gum.
In some cases, a tiny fraction of the jawbone may be removed to properly expose the root.
The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments.
The root will be sealed using a retrofill (filling material) and the dentist will suture the gum with several stitches.
After several days, the dentist will remove the stitches, and the connective tissues will fully heal several months after the procedure.