Medically Reviewed
by Dental District
Medically Reviewed by Jilian Lopiano

When endodontics is insufficient in order to treat an infection that affects the tooth’s root and adjacent tissues, a treatment called apicoectomy is required.

What is apicoectomy?

Apicoectomy or root canal surgery is a surgical intervention that is performed to end an infectious process in the tooth’s root and adjacent areas, which usually causes a lot of pain to the patient. The surgery consists of opening the gum in the area next to the infected tooth to extract the root’s apex or the tip, as well as other tissues that have been affected. Subsequently, the root canal is sealed with a substance called trioxide aggregate material (MTA) and the wound is sutured.

Apicoectomy is considered a minor oral surgery, which must be performed by a dentist with surgery or endodontics specialty.

When is apicoectomy necessary?

Apicoectomy is an intervention that can save your tooth from extraction, since only the dental pulp is removed (using endodontics), but the root and the external part of the tooth are preserved. This surgery is usually performed only if other treatments have failed, such as endodontics, if it is impossible to access the root’s final end or apex, if there are false canals in the tooth, one has fractured or if any of the instruments used in the endodontics could not be removed.

Other cases in which apicoectomy is recommended are:

  • Massive destruction of the root portion
  • Severe bone loss
  • Destruction of bone up to the middle of the root
  • An affected area very close to the maxillary sinus
  • Infections after endodontics, even if it has been well done
  • False root canals, or fractured root canals
  • If it is impossible to access the end of the root

Reasons why endodontics or re endodontics fail?

An infected and irreversibly damaged dental pulp due to deep caries will be inflamed, sensitive to heat or cold, and with a high accumulation of bacteria. When they cannot be removed by root canals, the bacteria will remain in the canals and the infection returns, along with the symptoms.

Endodontics in Mexico have a 90% success rate, and can fail if the dental pulp is damaged, has fissures, or vertical fractures that are difficult to diagnose (even with an x-ray). If during the root canal treatment part of the pulp was perforated, or if the length of the canals was not calculated correctly, it is a poorly done endodontics.

In a re endodontic procedure, where the process is carried out again, it will be called a failure, if the sealing materials cannot be removed from the ducts in order to clean and fill again. Apicoectomy is an alternative to not having to extract the tooth.

When is it not advisable to do an apicoectomy?

In general, apicoectomy is a safe and effective minor surgery, but it is only recommended if root canal treatment has been ineffective. In addition, the specialist may choose not to perform it in case he finds the following:

  • In patients with severe blood coagulation problems that may cause uncontrolled bleeding
  • If the tooth has a fracture along its entire length
  • In people with very advanced periodontal disease
  • Chronic conditions that may interfere with coagulation or anesthesia

Apicoectomy process

The apicoectomy is performed under local anesthesia, so the surgeon will apply an injection to numb the area so that you do not feel pain. He will then make a small incision in the gum and expose the infection at the tooth’s root end with a special dye to easily see the cracks. If fractures are found, the surgeon will probably stop the apicoectomy and opt for a tooth extraction.

If no fractures are found, the surgeon will remove the infected tissue as well as a few millimeters of the apex or root tip. The canals are then examined, cleaned with an ultrasonic instrument, filled with inert material, and sealed with a filling. At the end of the procedure, a small bone graft is placed in the affected site and the gum covering the root is sutured.

The apicoectomy time varies between 30 and 90 minutes, depending on the complexity of the case.

Post – surgical recommendations

After the intervention, it is normal to have inflammation and pain in the treated area. Your surgeon will likely prescribe antibiotics and pain relievers to ease the pain and help reduce inflammation. You can apply ice or cold compresses to reduce inflammation, and remember not to chew on the treated side, avoid red and processed meats, fats, and very hard or crunchy foods. Alcoholic beverages consumption and cigarettes should be paused at least until healing.

The surgeon will probably recommend that you do not do physical activities or sports for at least 72 hours and rest with your head slightly raised or supported by two pillows.

We also recommend that you maintain a soft diet, do not gargle or spit, so as not to affect the stitches, brush your teeth gently and change your toothbrush.

Success rate and surgical apparatus for the intervention

Apicoectomy has a 92% success rate, and only in cases of deep cracks or root fractures is it considered unsuccessful, as the tooth must be extracted. In general, root canal surgery is safe and effective in most cases.

To carry it out, the surgeon requires a surgical microscope that allows him to examine the tooth’s ducts in detail. This device increases vision up to 250 times and helps the Dentist in Tijuana to be very precise when performing the procedure.

Apicoectomy, how much is the procedure?

In the United States, the price of a dental apicoectomy is an average of $1,300 USD, while in Mexico the average is $400 USD in certified, high quality clinics with excellent opinions, such as The Dental District, dental clinic in Tijuana, where you will find the right treatment for you such as dental braces in Tijuana or Dental implants in Mexico.

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