The teeth are held firmly in place by strong roots that extend into the jawbone. The end or tip of each root is called the apex. A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When inflammation or infection persists after a root canal treatment, an apicoectomy may be required.

What is an apicoectomy?

An apicoectomy procedure involves one of our Boston dentists removing the tooth’s apex (or root tip), followed by a filling procedure to seal the root from further infection. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. When left untreated, infected roots can damage other teeth, spread infection and cause regression of the jawbone. An apicoectomy will rarely be considered by the dentist unless a prior root canal treatment has failed.

Reasons for getting an apicoectomy:

• Small adjoining root branches: Roots of the teeth are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
• Blocked root canal: In some cases, the dentist is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. Infection and debris can quickly affect adjacent teeth.
• Narrow or curved root canals: When the root canal is poorly shaped, the endodontic files cannot reach the root tip and continuing infection or re-infection can result.

What does getting an apicoectomy involve?

Prior to the surgery, one of our Boston dentists will prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection. Panoramic X-rays will then be taken to help plan the apicoectomy, which will be performed under local anesthesia.

On surgery day, the dentist will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material) and the dentist will suture the gum with several stitches.

An apicoectomy does not require an overnight stay, and full aftercare instructions and pain medications will be provided, as needed. After several days, the dentist will remove the stitches, and the connective tissues will fully heal within several months after the procedure.

If you are experiencing any pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately to schedule an appointment.