If a person has had a root canal procedure done, and it becomes infected again, the problem can be tracked down to near the apex of the root. That is when an apicoectomy is done. However, doctors consider a second root canal treatment before doing an apicoectomy in most cases.
Doctors perform apicoectomy to remove the root tip, or apex, along with the infected tissue. Then they seal the root end by placing a filling there. An apicoectomy is done because sometimes, even after a root canal procedure, infected tissue can remain in the tiny branches of canal. This may lead to re-infection later or may prevent healing of the tooth.
An apicoectomy is sometimes called endodontic microsurgery because it is often done using an operating microscope. It is done only after one root canal has been performed on an infected tooth and re-treating it is either not possible or has not been successful.
An apicoectomy can be considered in a case when a tooth has a crown or is part of a bridge. Retreatment of the root canal here would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this.
Apicoectomy is carried out to save the tooth in cases where root filling is unsuccessful or impossible. Initially an X-ray is taken to view the infected apex. Instruments used for the procedure are:
1. Scalpel - initial incision into the gum
2. Periosteal elevator – to raise the flap of the gum
3. Straight hand piece and bur – to cut into the bone to expose the infected apex. Now the apex is cut off
4. Mitchells Trimmer - to scrap out the infected tissue. The root canal filling is checked and if necessary additional filling material is inserted usually GIC or ZOE (Retrograde Root Filling)
5. Suture Needle and Silk
6. Needle Holder or Spenser Wells Forceps
If the tooth that has been treated with root canal, gives you pain or swells, you must contact your dentist. Sometimes, it may be nothing more than a fistula (a pimple that develops near the tooth often goes away and then come back).
The endodontist will review the risks of the procedure at the consultation visit. Make sure to ask questions if something the dentist has told you is not clear. The main risk is that the surgery may not work and the tooth may need to be extracted.
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