Endodontics is the branch of dentistry that is involved with the inner portion of the teeth: the pulp and the tooth roots. Dentists and endodontists perform root canals that can save teeth that would otherwise die or need to be extracted. A tooth that has been treated with root canal can last for the patient’s lifetime, but sometimes problems arise after a root canal, or complex structural issues can make root canal only partially effective. In these types of cases, endodontic surgery may be recommended to save the tooth. One of the most common types of endodontic surgery is called an apicoectomy.
A root canal procedure cleans out dead and diseased tissue from inside the tooth. Root canal has a success rate of around 95%, but in rare cases, infection can return after a root canal. Another problem that arises in some cases is that the canals are too narrow for the dental instruments to enter. When a root canal fails to clean out the infection entirely, or when infection recurs after a root canal, an apicoectomy may be the best way to save the tooth.
During an apicoectomy, the dentist or endodontist opens the gum tissue to expose the bone and root of the tooth. Any infected tissue is removed, and the tip of the root is also removed. The root tip is usually sealed, and then stitches are made. As healing progresses over the next few months, the bone heals around the tip of the root.
Apicoectomies are performed under local anesthesia and are considered to be minor surgery. Because of the precision instruments involved and the frequent use of a microscope during the procedure, apicoectomy is a type of microsurgery. It usually takes about half an hour to 90 minutes to complete.
An apicoectomy is only performed after one or two root canal procedures have been performed and infection has returned or is still present. All endodontic procedures aim to save teeth; the only other alternative to having these procedures performed is to have the tooth extracted. While there are viable options for tooth replacement such as implants or bridges, saving your natural teeth is the most often recommended course of action.