Apicoectomy (Endodontic Surgery)


Definition: Excision of the apical portion of the root of a tooth through an opening in overlying tissues of the jaw.


Sometimes, dental procedures can sound a lot more confusing and terrifying than they really are, simply because the medical names can sound mystifying to most of us. So, if your dentist says you need an “apicoectomy,” what does that mean? What does the treatment involve? And more to the point, is it going to hurt?


An apicoectomy is a surgical procedure for people who have an infection in the root of their tooth. Normally, infections in and around the root of the tooth are dealt with by root canal treatment. This basically means that your dentist cleans around the root of your tooth, ensuring that any plaque, decay, and infection are removed so that the tooth and gum can become healthy once again.


In some cases, however, root canal treatment is not sufficient to stave off infection, which can return. Therefore, your dentist has a choice. To once again, attempt root canal treatment and clean away the infection, even though this has failed previously. Or, an alternative procedure can be attempted, which may hopefully yield more lasting results.


Often, if the returning infection is spotted early, your dentist will choose to attempt a second root canal treatment, and this may clear up the infection once and for all. If the infection is more deep-seated, then your dentist may recommend an apicoectomy.


A simple way of thinking about it is you have an infection around the root of your tooth. If you let it continue, then the tooth will decay, start causing you pain and at some point, it will fall out. From a dental surgeon’s perspective, the goal is to stop your loss of that tooth.


The first step is root canal treatment, a.k.a “let’s clean it up and see how it looks.” If the infection returns after root canal therapy a second procedure may be necessary to eradicate the infection completely. So, what next?


The dental surgeon can either admit defeat, concede that the tooth cannot be saved, and perform an extraction. But as mentioned above, tooth removal should be a procedure of last resort – the more of your natural teeth you can keep, the better. So, your dental surgeon does not give up yet. Instead, your dental surgeon explores the possibility of an apicoectomy.


The first step is to cut into the gum so that your dentist can take a closer look at the infected root. At this point, the right solution is still to be decided. If the tooth root is badly cracked, then it may still be susceptible to infection in the future – so the only option may be to perform an extraction.


However, if the tooth root sound, then your oral surgeon will clean away the infection around the root as during root canal treatment. However, to stop the root becoming infected further in the future, the dentist will perform an extra surgical step, known as an apicoectomy. This involves slicing away the tip of the root. This means that the entire infection has been removed and the end of the tooth root can be cleaned and sealed, thus better protecting it in the future.


Therefore, if your dental surgeon is considering performing an apicoectomy, you should not be fearful. You should, in fact, be glad that there is still an opportunity to save your tooth. However, an apicoectomy is not universally successful. It is possible for an infection to recur, necessitating extraction of the tooth later.

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