Apicoectomy (Periapical Surgery)

Generally, a root canal is all that is need to salvage a tooth from being extracted. Occasionally there may be a point in which the root canal treatment will not be sufficient enough to heal the tooth and your primary dentist may recommend apical surgery or root-end surgery.

Periapical Cyst

Mandibular cyst developed from a tooth with a failed root canal.

What is an apicoectomy?

An apicoectomy, root-end resection or periapical surgery, is the removal of the root tip and the surrounding infected tissue of an abscessed tooth. This procedure may be necessary when inflammation and infection persists in the area around the root tip after root canal therapy.

When to call a professional?

If you are having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist. Sometimes after a root canal a pimple develops near the tooth. This pimple will often go away and then come back, this is called a fistula. You may notice pus draining from the fistula. The fistula is a sign that there is an infection and your body is draining it out through the pimple. There is usually no pain in this situation, but you may notice a bad taste or odor in your mouth.

How is the surgery done?

The oral surgeon will make a small incision (cut) in your gum and lift the gum away from the tooth and bone. The infected tissue will be removed along with the last few millimeters of the root tip. 

To complete the apicoectomy, the surgeon will clean and seal the end of the tooth's canal. The cleaning usually is done under a special microscope using ultrasonic instruments. The light and magnification allow the surgeon to see the area clearly. This increases the chance that the procedure will succeed. Then an X-ray of the area is taken before stitching the tissue back in place. 

Most apicoectomies take 45 to 60 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

After the procedure

Following the apicoectomy, there may be a little discomfort and a bit of slight swelling as the incision heals. To alleviate the slight pain and discomfort, proper medication will be given after the procedure.