When an infection at the root tip doesn't clear up with a root canal, many people think the only option is to remove the tooth. That isn't always the case: an apicoectomy is a minor surgery that in many cases makes it possible to save the natural tooth. Dr Paola Vella, our surgeon at Somriures Dental Gavà, explains what it involves.
What is an apicoectomy?
It's a surgical procedure in which the tip of the tooth root (the apex) and the infected tissue around it are removed, and the end of the canal is then sealed so bacteria can't get back in. It's considered the last resort to keep a tooth before extraction.
When is it needed?
- A previous root canal hasn't worked or the infection has come back over time.
- The tooth has a crown or post that would make redoing the root canal from inside very risky.
- There are very curved, calcified or branched canals that can't be fully cleaned with conventional root canal treatment.
- There's a cyst or lesion at the root tip that won't heal.
- There's a fracture at the root tip.
Symptoms that may indicate a root infection
- Pain when biting or touching the tooth.
- Swelling or a «pimple» on the gum that comes and goes (fistula).
- A bad taste in that area.
- Sometimes there are no symptoms and it's found on a routine X-ray.
What the procedure involves
- Diagnosis: X-rays and, if needed, a CBCT scan to see the size of the lesion and the root anatomy.
- Local anaesthetic: the area goes numb and you won't feel pain.
- Access: we make a small incision in the gum to reach the root tip.
- Cleaning: we remove the infected tissue and the root tip.
- Sealing: we seal the end of the canal with a biocompatible material.
- Stitching: we close the gum with a few stitches.
It's a simple procedure that usually takes 30 to 60 minutes, depending on the tooth.
Recovery
Recovery is usually quick with little discomfort. There may be some swelling for the first few days, controlled with cold and the medication we prescribe. Stitches are removed after about a week. The bone around the root regenerates over the following months, which we check with follow-up X-rays.
What if the tooth can't be saved?
If the tooth has a large fracture or there isn't enough support, the best option may be to extract it and replace it, for example with a dental implant. We always explain the alternatives before deciding.
Frequently asked questions
Does an apicoectomy hurt?
Not during the procedure, thanks to local anaesthetic. Afterwards, discomfort is usually mild.
Is the tooth weaker afterwards?
Only a small part of the root tip is removed. In most cases the tooth remains functional for many years.
Is an apicoectomy or an implant better?
Whenever possible, keeping the natural tooth is the first choice. If the tooth's prognosis is poor, an implant may be more predictable. We assess it with you.
