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Apicectomy | Bath Oral Surgery Clinic

Apicectomy

Apicectomy

What is an apicectomy?

This is a surgical procedure to:

  • remove an infected tooth root tip
  • clean out the surrounding infection
  • place a filling to cap and seal off the new end of the tooth.

Why do I need an apicectomy?

The most common reason to consider an apicectomy is persistent infection around a root tip, after conventional root canal work. This infection can cause pain, swelling and discharge over the top of the tooth in the gum and can get quite extensive (see diag.1).

In some cases, it is preferable to repeat the root canal therapy, but this is not always possible or practical. Surgery is then the best option to deal with the infection.

The suitability of apicectomy treatment can only be determined after thorough examination of the tooth’s appearance and x-rays.

  1. Jaw bone.
  2. Area of inflammation/infection surrounding tooth root tip.
  3. Root canal treatment within tooth.
  4. Healing area around tooth root tip.
  5. Specialised filling within root tip.

How is the apicectomy carried out?

Local anaesthesia is used to numb the area around the tooth. The gum tissue is then gently raised away from the tooth to allow access to the infection and this area is thoroughly cleaned out. The tip of the tooth root is then removed and special cement placed over the new end of the root. This sets very hard and seals off any open channels in the root which could lead to another infection. The gum tissue is then put back into place to allow for healing. (see diag.2).

Apicectomy treatment carried out on an upper central incisor

  1. Jaw bone.
  2. Area of inflammation/infection surrounding tooth root tip.
  3. Root canal treatment within tooth.
  4. Healing area around tooth root tip.
  5. Specialised filling within root tip.

Apicectomy treatment carried out on an upper premolar

  1. Jaw bone.
  2. Area of inflammation/infection surrounding tooth root tip.
  3. Root canal treatment within tooth.
  4. Healing area around tooth root tip.
  5. Specialised filling within root tip.

How successful are apicectomies?

Success rates for first apicectomies are typically 75-80%, (assessing patients clinically and with x-rays three months after the operation). It is possible that the procedure will not completely resolve the problem and success rates are inevitably reduced for repeat apicectomies.

How long will the operation take?

This depends on the position of your tooth, the treatment required and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 60 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Stitches are used in the operation to help complete the surgery. A very fine size of thread is used to achieve a good cosmetic result, which is especially important if it is for a tooth at the front of your mouth.

These stitches are dissolvable and so should disappear after about two weeks.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery, with some discomfort. Bruising is usually most obvious after two to three days and varies between patients. It normally resolves itself in 10 to 14 days.

Following an apicectomy, there can be a small amount of recession of the gum margin on the front of your tooth. This is not necessarily a problem in itself, but can affect the tooth’s appearance.

The surgical techniques we use are designed to minimize this recession. Any new restorations (such as crowns) planned for your tooth by your dentist should only be placed once the gum margin has settled.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day. Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

Postoperative advice

Find out how to help bring about a quick recovery after an operation.

View Advice