Roots hold your teeth in place and extend them into your jawbone. Your front teeth usually have a single root whereas other teeth like your molars and premolars have two or more roots. Nerve and blood vessels enter your tooth through the tip of the root, known as the apex. The nerves and blood vessels travel through your root via a canal, and into the pulp chamber, which is inside the crown (the visible part of your tooth).
When you receive root canal treatment, the canals are cleaned and all tissue that is inflamed or infected is removed. When the inflammation or infection won’t go away or develops after a root canal, an apicoectomy may be necessary (see Figure 1).
The canal in your root is very complex and has many small branches extending from it. After a root canal, sometimes infected debris can linger in these branches. This debris can prevent healing or cause re-infection. During an apicoectomy, the apex or the root tip is removed along with all infected tissue. A filling is then placed at the end of the root to seal it.
An apicoectomy is only performed after the tooth has had at least one root canal procedure and cannot be retreated or was not successful in retreatment.
Retreatment is not possible when the tooth has a crown or is part of a bridge. Retreatment of the root canal requires cutting through the crown or bridge which may destroy or weaken the prosthesis. An apicoectomy would be the proper solution in this situation.
Dr. Hane will cut and lift your gum away from the tooth. All infected tissue is removed as well as the last few millimeters of the root tip (see Figure 2). The tooth’s canal will then be cleaned and sealed by using a special microscope and ultrasonic instruments (see Figure 3). By using these tools Dr. Hane will have an increased chance of clearing the area entirely.
Apicoectomies usually take 30 to 90 minutes. The length of the procedure is dependent upon the location of the tooth and the root structure’s complexity. Front teeth are usually the shortest and molars generally take the longest.
Dr. Hane will instruct you on what medicines to take and what you can eat or drink. Ice should be applied to the area 10 – 12 hours after surgery.
The area may swell and bruise, and may be more swollen the second day following the procedure. Pain can be controlled with ibuprofen (Advil, Mortin, etc.). Avoid brushing the area to allow for healing. You should not eat hard or crunchy foods, or smoke. Make sure you do not lift your lip to inspect the area because it can loosen the stitches and disrupt the formation of a blood clot which is necessary for healing.
All soreness and swelling are gone within 14 days. Stitches will be removed between two and seven days following your procedure. Many people say that recovery from an apicoectomy is easier than the original root canal treatment.