November 23, 2014
Every tooth has a root that keeps it anchored in the jawbone. The tip of the root is where the blood vessels and the nerve enter and reach the center of the tooth. A persistent infection that recurs after root canal treatment may require an apicoectomy. This is a surgical solution which helps saving the tooth if the root canal treatment has not been successful. In such situations, the removal of the root apex, or an apicoectomy, is the only way to save the tooth.
Apicoectomy Indications
If the infection is not treated effectively, it can lead to tooth loss as well as spread of infection to the surrounding area. An apicoectomy is only considered after failure of a root canal treatment. Often the reason behind a failed endodontic treatment is that root canals have a complex structure with tiny lateral branches. These may have residual infection left in the surrounding tissue which sometimes leads to reinfection. Though the front teeth have single roots, molars and premolars at the back of the mouth have two or more roots. This increases the chances of lingering infection. Another reason why root canal treatment may have failed is that a fragment of a file from a previous treatment may be lodged in the canal. Sometimes, the root canal may be curved or oddly shaped, making it difficult for the dentist to access the tip and clean it.
Contraindications
An apicoectomy may not be feasible in certain conditions where the tooth canal is near other structures such as maxillary sinus, mandibular canal near the apex of the second molar, or mental foramen near the second premolar tooth. In such situations there is a risk of injury involved and will be carefully evaluated before the procedure is attempted. Besides, removal of the tip is not possible for a tooth whose root length is short.
Procedure
This is a simple procedure that is carried out under local anaesthesia. It should take about an hour to complete the apicoectomy depending on the complexity of the root canal. Generally, more time is needed for the premolars and the molars. A minor incision is made in the gum so that the gum can be separated from the bone. Next, a little window in the jawbone is created with the help of a drill to access the infected area. The infected tissue around the root tip is carefully cleaned and about 2 to 3 mm of the root is removed from the apex. The root is then sealed with a filling to prevent infection yet again. As a rule, dissolvable or non dissolvable sutures are used for stitching the gum back into position.
Precautions and aftercare
Painkillers and antibiotics are prescribed as required after an apicoectomy. There may be some swelling for a couple of days which will gradually subside. It is advisable to apply ice on the affected area every 20 minutes or so for about 12 hours following the procedure. It is better to avoid very hard and crunchy foods such as nuts till healing occurs. The patient should not touch the area with the tongue as this can delay healing. It is good practice to rinse the mouth with mouthwash or salt water to clean the affected area as it will be difficult to use a toothbrush in the beginning. There may be some numbness which wears off in a month or so.