Surgical Endodntics Questions
- What is an apicectomy?
- Why is an apicectomy necessary?
- Where is the surgery carried out?
- Example Case
What is an apicectomy?
An apicectomy is the surgical removal of the root apex or tip of the root, the preparation of the resected root end to receive a root filling and the placement of the root filling.
Why is an apicectomy necessary?
There are three primary reasons why the surgical approach may be preferred:
If the infection fails to clear following a conventional root treatment and redoing the root filling (retreatment) looks very challenging because of complicated root anatomy and previous procedural difficulties (ledges, retained instruments, perforations) then the surgical approach may be justified.
If there is significant overlying dentistry retained by a post/core which is perfectly intact and the associated risks of removing all the dentistry to access and treat the problem tooth are high then the surgical approach may be justified to resolve this problem.
Occasionally despite careful radiographic and clinical evaluation no obvious cause of failure may be identified and surgical exploration of the problem tooth may be justified.
Where is the surgery carried out?
The surgery is considered to be a minor oral surgical procedure and can be carried out in the dental surgery under local anaesthetic. Like any surgical procedure there are three potential complications which follow surgery (pain, swelling and bruising). It is important to follow the post surgical advice given.
Example: Lower Incisor Surgery
In the x-ray images below, the problem tooth can be seen clearly circled in red. The black area of infection around the base is the most obvious sign here. A complication with this case is that there is a post/core and crown present. This makes the conventional approach of going down the root canal system significantly more difficult as this dentistry would first need to be removed. The picture to the right taken through the operating microscope and viewed through a mini mirror shows the actual resected root tip. It is clear to see that the root filling (orange circle in the image) does not obturate/fill the whole root canal space which implies that not all this space has been disinfected and so the remaining bacteria repopulate the space and cause infection.
A minor surgical procedure under local aesthetic is required. The root end is removed and the infected root canal space is opened up and prepared. A surgical root filling is then placed into this preparation.
The post-op xray and image below show the situation after the surgery has taken place. The image on the right now clearly shows the entire cavity occupied by the new filling. The black infection area is still evident on the X-ray but this will heal in time.
14 months after the surgery the x-ray below shows the successful outcome: the black area of infection has completely disappeared and the filling completely occupying the cavity is soundly in place.
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