Your teeth are held strongly in place by firm roots that extend into the jawbone. While premolars and molars tend to have several roots, the front incisors only have a single root. The tip or end of each root is identified as the apex. The apex is where the blood vessels and nerves enter the tooth, and assists in the flow of blood to the crown (the area of the tooth you can view in your mouth).
A root canal treatment refers to the removal of inflamed and infected tissue and the cleaning of the canals within the root. When the infection or inflammation remains after the root canal treatment, an apicoectomy may be needed. An apicoectomy is the elimination of the root tip (or apex), followed by a filling treatment to seal the root from continued inflammation. When not treated, inflammed roots can infect other teeth, spread inflammation, and cause degeneration of the jawbone.
Why an apicoectomy?
inflamed and infected soft tissue near the root of a tooth can be very debilitating and painful to the patient. The reason for an apicoectomy is to remove the inflammation in the tissue and to eventually keep the tooth and save it from extraction. An apicoectomy is not considered by the dentist unless a prior root canal treatment has not worked.
There are 3 reasons why an apicoectomy may be necessary:
- Small Nearby Root Branches – Roots are very intricate and can contain many microscopic branches. If these small branches cannot be sealed and sterilized when the root canal treatment is done, infection can remain.
- Blocked Root Canal – At times, the dentist is unable to completely clean a root canal because it is impeded by a broken file remaining from prior root canal treatment. Debris and inflammation can sometimes affect nearby teeth.
- Curved or Narrow Root Canals – When the root canal is not shaped properly, the endodontic files cannot reach the tip of the root. ongoing infection or re-infection can then happen.
What does an apicoectomy involve?
Before the procedure, the dentist will commonly prescribe an anti-inflammatory or antibiotic medication to combat the underlying infection. The dental team will then take a panographic film to enable the planning of the procedure under local anesthetic.
After making a tiny incision in the gum and exposing the root, a visual diagnosis is made by the dentist. In some cases, a minor portion of the jawbone is removed to expose the root. The tip of the root and any tissue will be removed using ultrasonic instruments. The root will be covered using a filling material (retrofill) and the dentist will suture the gum with 2-3 sutures.
The complete post-op insructions and pain medications will be given as required. After 2-3 days, the dentist will remove the sutures, and the tissues will completely heal several months after the procedure.
If you are experiencing any similar symptoms or signs, such as swelling or pain, that could be associated with the tooth that has had a root canal, please contact our office immediately to schedule an appointment.