Who Needs an Apicoectomy and Why?

Dr. Kavita Tarale, Specialist Endodontist

A root canal procedure is done to treat and save a tooth that is damaged, infected or badly decayed. Most root canal infections can be managed by conventional root canal treatment. But in few cases where the infection persists even after root canal treatment or re-treatment, an apicoectomy is needed to clear the infection and fix the problem. Our Specialist Endodontist Dr. Kavita Tarale tells us more about this procedure.

What is apicoectomy?

The most common surgical endodontic procedure is called apicoectomy or root-end surgery. Apico means apex or root tip and – ectomy means removal or resection.

Apicoectomy is a minor yet sophisticated microsurgical procedure where the very end of the tooth’s root is removed along with the infected gum tissue attached to the root tip. The apex is then sealed with a filling to prevent micro leakage.

What is the apicoectomy procedure like?

Once the root canal procedure is completed, the endodontist will give the patient local anesthetic to numb the surgical site. The gum is cut and lifted to access the root tip. The infected tissue is curetted and the root tip is resected. The 3-4mm root canal is cleaned and sealed with biocompatible material. The endodontist will then suture the tissue back in place. The entire procedure is done under microscope and using ultrasonic instrument in a sterilized environment.

Will the procedure hurt?

The endodontist will administer local anesthesia to make the treatment more comfortable. Patients may experience slight discomfort while recuperating which is normal for any surgical procedures. Patients will be prescribed with appropriate pain medications to help ease discomfort.

How long is the apicoectomy treatment?

The treatment is done in single appointment. The procedure takes about 90-120 minutes depending upon the tooth location and complexity of the roots.

What if the patient does not want to do the surgery?

If the patient is not willing to get this surgical procedure done, then the tooth needs to be extracted and an implant can be surgically placed to replace the missing tooth.

Is a Root Canal Treated Tooth Susceptible to Decay?

By Dr. Kavita Tarale, Specialist Endodontist

The only difference between a normal tooth and a root canal treated tooth is the absence of nerve supply and blood supply to the root canal treated tooth. And hence, there is no sensation to hot and cold food.

However, teeth that have had root canal treatment are at a risk of formation of tooth decay and gum disease, just like any other tooth. And if allowed to advance, either of these conditions can ultimately lead to tooth loss.

I have noticed that some of my patients think that since when a crown is done, very little or no original tooth structure is visible above the gum line, there is no chance of tooth decay on that tooth. A crown is connected to a natural tooth underneath it and because of this, decay can form around the edges of a crown.

Dr. Kavita Tarale, BDS, MDSSpecialist Endodontist

With proper care, root canal treated teeth can last life time. Root canal treated teeth tend to dry out, become brittle and can break. With a filling and crown, the tooth can be protected against breakage but not against decay. Proper brushing and flossing along with regular dental checkups can help prevent decay as well as any gum problems.

Dental decay or caries is an infectious disease caused by specific bacteria. But just having the bacteria present in your mouth does not mean you will develop decay. Other factors must be present. What are those other factors?

The most important other factor is sugar. When you ingest a meal with lots of simple sugars (this includes candy and sugary sweets, but also food with large amounts of sucrose), the bacteria consume those sugars. Upon consumption of those sugars, they release acid. That acid goes on to attack the mineralized part of teeth and weaken them. Over time, the hard enamel shell of the tooth is dissolved which leads to cavitation.

This decay process can occur on any surface of the tooth regardless of whether the tooth is vital (tooth with nerves and blood supply) or non vital (tooth that no longer has access to nutrients and blood flow). Hence, good oral hygiene practice at home along with a regular dental checkup is mandatory to maintain a healthy oral cavity.