An apicectomy is a surgical procedure that attempts to remove infection, usually the result of a failed root canal surgery, from the tip of the tooth root (apex).
When a root canal fails it is usually due to an unusual and undetectable tooth anatomy, small nerve canals that cannot be instrumented (cleaned), cyst formation or a cracked tooth.
Most of these failed root canals can be saved, with the exception of a severely cracked tooth.
The resulting infection of a failed root canal may be present in the absence of pain and X-ray evidence is usually required to diagnose the problem. An infection shows up on an x-ray as an unresolved black circle around the tooth. Sometimes a gum boil, or pimple, might be present in the gum.
An apicectomy is usually performed only after a tooth has had at least one root-canal procedure and usually a second root-canal treatment.
Before an apicectomy, it is more than likely that you will have a consultation with your dentist. If you have high blood pressure or know that you have problems with adrenaline (epinephrine) in local anesthetics, let your dentist know at the consultation.
The procedure itself takes between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest; those on lower molars generally take the longest. The long-term success rate or prognosis for a tooth is significantly reduced when an apicectomy is needed. Apicectomy is more difficult to perform in posterior teeth because of difficulty in vision, surgical access and the complexity of multi-rooted teeth.+
During the operation the surgeon, or endodontist (root canal specialist), will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue is removed along with the last few millimeters of the root tip. If the tooth is cracked or fractured, it may have to be extracted, and the apicectomy will not continue.
To complete the apicectomy 3 to 4 millimeters of the tooth's canal are cleaned and filled.