Your teeth consist of the crown and the roots. The roots are what hold your teeth to the jawbone. Front teeth have one root while the teeth you use for chewing, your premolars and molars, have two roots or more.
The tip of a root is called the apex and it’s through this tip that nerves and vessels that carry blood and nutrition enter the tooth, traveling into the pulp chamber through the root canal. The pulp chamber is situated in the crown, which is the top part of your tooth that’s visible in your mouth.
When a dentist performs a root canal, he uses specialized dental files to clean the canals and remove tissue that’s inflamed and infected. Sometimes, after a root canal is performed, an infection develops and will not go away. Because root canals are complex, it’s not always possible to get all the infected tissue, as some infection could have seeped into the small canals that branch off from the main canal.
In such a situation, a procedure called an apicoectomy has to be performed in order to remove the apex and infected tissue. The apex is then sealed using filling. This procedure is also known as an endodontic microsurgery because it’s performed through an operating microscope.
When an apicoectomy is done
An infection after a root canal usually results from a problem in the apex. Such a problem can be fixed using root canal retreatment and only when the retreatment has failed will an apicoectomy be considered. If a tooth serves as a bridge support or if it has a crown, then a retreatment is not an option and the dentist will perform an apicoectomy.
An apicoectomy is performed by an endodontist. In some situations, you can also be referred to an oral and maxillofacial surgeon. Before the procedure, you’ll be given a mouth rinse and medication meant to reduce inflammation. The dentist will also take x-rays to guide the procedure.
How an apicoectomy is done
A small cut is made on your gums and the gums in that area are lifted to reveal teeth and bone. The dentist will then drill into the root and remove the apex and any infected tissue. The apicoectomy is completed by cleaning and sealing the end of the tooth canal. A final x-ray is taken before the tissue is stitched.
The procedure lasts 30 to 90 minutes depending on where the tooth is located and also on how complex the root structure is.
You will be given medication and advised on what to ingest or not ingest. You should also keep the treated area under ice for the first 12 hours following the surgery. Swelling and bruising will be more pronounced on the day following the surgery and you should keep up with pain and inflammation medicine for faster healing.
Do not chew hard foods, brush the area, or smoke. Also, don’t try to inspect its appearance with your tongue, by touching or lifting your lip. Doing all these things will slow the healing process.
After 14 days, the swelling and soreness should completely subside.