Apicectomy

Our teeth are held together in place in the mouth because of the roots that extent into the jawbone. Some of our teeth have only one root like front teeth, while others like molars and premolars have more than one root.

The apex of a tooth is actually the tip of the roots is the area where blood vessels and nerves enter the teeth. These nerves further travel through the canal of the roots and then into the pulp chamber. Pulp chamber is located in that part of the tooth which is visible in our mouth called crown. Any infected or inflamed tissues are removed off the canals during the root canal treatment. But root canals have a network of complex branches off the main canal and in many cases infected debris can still be found even after root canal treatment. This can stop the healing process and may even be instrumental in causing further infections. This is where Apicectomy becomes necessary and plays its part. Usually done under an operating microscope, Apicectomy is often called Endodontic Microsurgery. Roof tip or apex is also removed along with infectious tissue in Apicectomy.

Apicecomy and Root Canal Treatment

If you have undergone to unsuccessful root canal treatment in the past and your tooth has again become infected, then the problem may be detected near the apex of the root. With the help of advanced technology doctors can now detect other not properly treated canals. Apicectomy can be avoided by doing another root canal treatment. Apicectomy is done only after two unsuccessful root canal treatments, main purpose of which is to avoid the tooth extraction and fix the problem.

An Apicectomy is not that simple a procedure. It involves many risks that Endodontists review during the consultation period. One of the biggest risks is that it may not work at all and tooth extraction may have to be done. Another risk is related to the location of the tooth. For example if the tooth is located on the back of the upper jaw, then Sinuses may be at risk of infection. You may have to use some antibiotics to prevent the infection. On the other hand if the tooth is located on back of lower jaw, then major nerves may be at risk. This risk of damaging nerves is managed by using X-Rays for determining the closeness of the tooth to the nerves.

The Apicectomy Procedure

Preparation for Apicectomy or the steps taken prior to Apicectomy are of utmost importance. An Endodontist or a Dentist having experience in endodontic surgery will perform the Apicectomy. Several X-Rays of the tooth and surrounding bone may be necessary prior to Apicectomy. Patient will be treated with antimicrobial mouth rinse, antibiotics and other medications to reduce inflammation. Patient’s medical and dental history is very important prior to Apicectomy to let the surgeon know of any pre-existing medical conditions that can complicate the process. In this respect patient’s regular dentist can provide vital information.

To have access to the root, Endodontist will first cut and then lift the gum away from the tooth. He will remove the infected tissue and after that will also remove the remaining root tip. Endodontist will then have to take the decision whether apicectomy is to be performed or extraction of the tooth is only option. He will do this by highlighting the breaks and cracks in the tooth. If there are too many breaks and cracks then tooth extraction will be performed. If he chooses to do Apicectomy, he will cleanse and then close the end of tooth’s canal. A special microscope that has ultrasonic instruments is used for cleaning because its light and magnification gives a better view to Endodontist of the area thus increases the chances of success. X-Ray of the area is done before stitching the tissues back into place. Length of this whole process depends on two things, complexity of the root structure and the location of the tooth. It takes less time if done on front teeth, and more time if done on molars. The whole Apicectomy surgery however takes from half an hour to one and a half hour.

After your Apicectomy

Although clinical Apicectomy ends here, but there is lot to be done. You may often have to apply ice on the operated area for some more than ten hours and also might need some medication as well. There is possibility that you experience swelling for a couple of days. Pain however can be controlled by using non-steroidal anti-inflammatory drugs like Advil and Mortrin as prescribed by the doctor. You should eat and drink in accordance with the instructions of the doctor. Smoking and crunchy and hard foods are to be avoided as well. Don’t brush or aggressively rinse the operated area. Apicectomy will be complete after the removal of stitches in couple of week’s time. All you need to do is meticulous care, because although it is a surgery yet people say that it is easier to recover after Apicectomy than Root canal treatment.

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