Sometimes there is no quick fix for a dental problem and you may be one of those unfortunate people that suffers from multiple issues with the same irritating tooth. You may have undergone a number of different treatments but the pain still remains and now your dentist is recommending an apicoectomy in order to save the infected tooth.
What is an Apicoectomy?
If an apicoectomy has been suggested by your dentist, then it means that your tooth cannot be successfully treated with the conventional root canal treatment. An apicoectomy is a minor surgical procedure performed by an endodontist in which the very tip of the tooth’s root is removed and sealed. The word “apicoectomy” literally means ‘end removal’. An endodontist is a dentist that specializes in the diagnosis and treatment of tooth pain from root canal disease and they are highly skilled at performing this type of surgical procedure.
Traditional Root Canal Treatment
Inside the center of a tooth (the pulp chamber) there is living tissue that contains nerves, blood vessels and connective tissues that keep the tooth alive. Tiny roots or veins (typically three) branch out from the pulp chamber to the ends of the tooth creating a root canal system. Endodontic treatment, more commonly known as root canal treatment, is needed when the pulp chamber becomes inflamed or infected. There are several reasons why this can happen including:
- deep tooth decay;
- repeated dental procedures to fix a tooth (large fillings); or
- tooth damage such as a crack, chip or even a fracture.
If the pulp dies from any of these causes, then the pulp chamber and canals also become infected. That infection can eventually spread into the surrounding bone and gum tissue around the tip of the root causing pain and discomfort.
Conventional root canal treatment involves drilling a small access hole into the pulp chamber through the bottom of the tooth. The Inflamed or infected tissue is then removed from the pulp chamber along with all root canals. The remaining space inside the tooth is then cleaned out, disinfected, filled, and sealed. A temporary or permanent filling material will then be placed over to cover the access hole. A permanent cap (crown) is often used to seal the access hole, replace lost tooth structure and to protect the tooth from biting stresses and further damage.
The success rate concerning the treatment of a root canal is over 95%. However, it is not 100% successful. For most people a tooth restored during a root canal could last a lifetime, as long as they continue to care for their teeth and gums. This treatment can typically be done by your dentist without the need for a specialist consultant and they may take x-rays in order to find all the root canals within the tooth. Endodontists also use radiographs or sometimes CBCT scans (cone beam-computed tomography) that create three-dimensional views in order to examine root canals and diagnose disease that might otherwise go undetected by ordinary practitioners.
If the Root Canal Treatment Fails
If you have previously undergone root canal treatment you will know that a lot of work goes into treating a root canal infection and it can take more than one visit to the dentist to have the treatment completed. For most people, the conventional root canal treatment is successful but root canals can become re-infected after treatment for a variety of reasons, such as:
- new or recurrent decay;
- previously undetected canals that remain sensitive; and,
- calcification of canals (a blocking of the canals that prevents them from being fully cleaned by conventional root canal treatment). This is typically caused either due to age or after a trauma to the teeth.
In some situations the conventional root canal retreatment is not feasible as it may jeopardize the continued use of the tooth. For example, if a tooth already has a crown in place it may require taking apart the entire restoration to access the root canal, which could further weaken the tooth. Patients that suffer from failed root canal issues typically complain of sensitivity to heat and infrequent biting pain. In these cases, a better alternative is to treat the infected tooth from the root end of the tooth (without removing the crown) with an apicoectomy.
The Apicoectomy Process
An apicoectomy is a surgical approach through the gum rather than the visible tooth. The gum area will be thoroughly numbed with local anesthesia and then a small incision is made through the gum tissue. The incision will be made near the infected root, giving the endodontist direct access to the infected peri-apical tissue (the gum tissue directly touching the tooth). This direct approach allows for the removal of any inflamed or infected tissue around the tip of the root without the need to drill directly into the tooth. After removal, a very small filling is placed at the end of the root canal to seal the canal and prevent further infection. A endodontist will then secure the gum tissue with a few sutures (stitches) to ensure that it is closed and will heal properly. In rare cases, if the infection has left a significant void, bone grafting and other techniques are used to help the bone grow and fill back in. Now that the infection has been removed the area will heal and return to normal function after a reasonable healing period.
When performing endodontic surgery, endodontists use state-of-the-art technology such as fiber optic lights, operating microscopes, and ultrasonic instruments that clean via high frequency vibration. Although the surgery sounds complex and daunting to many patients, these advanced technologies give endodontists a very precise view of the tooth, making the treatment quick, comfortable and successful.
It can be a long road of treatments for unfortunate patients that have had conventional root canal treatment fail but an apicoectomy can save teeth that otherwise would have been extracted. Once performed the tooth, bone and gum tissues that were previously infected will return to health and functional use for many years.
Let our experienced Apicoectomy endodontist in Charleston, SC, help you. Call us today!