Dental Apicoectomy: What Is It and What Are Its Benefits?

When a root canal treatment doesn't work and the tooth becomes infected again, a dental apicoectomy may be an option to consider. Here's what it's all about.
Dental Apicoectomy: What Is It and What Are Its Benefits?
Vanesa Evangelina Buffa

Written and verified by the dentist Vanesa Evangelina Buffa.

Last update: 07 December, 2022

When it comes to preserving a tooth with an infection in the mouth, endodontics is usually the solution. However, this procedure is sometimes not enough and it’s necessary to resort to a dental apicoectomy.

Dentists use this small surgical intervention to avoid removing the infected tooth from the mouth. When root canal treatments have failed, this practice can remove the infected tissue and thus preserve the teeth.

In this article, you’ll find out what a dental apicoectomy is, when it’s recommended, and what benefits it brings. In addition, we’ll tell you about the care to be taken after this procedure.

What is a dental apicoectomy?

A dental apicoectomy is a surgical procedure performed on the apex (root tip) of a root canalized tooth. With this intervention, it’s possible to eliminate infectious processes that persist after root canal treatment.

In this way, the discomfort that remains after root canal treatment is treated and possible complications are prevented. In addition, it avoids the extraction of the tooth that remains in the mouth, fulfilling its usual functions.

It is also known as endodontic surgery because this intervention is a complement to root canals. However, in this case, it’s based on treating infections that occur in the dental root.

Endodontics that are commonly performed in dental offices are responsible for cleaning the inside of the tooth. Special instruments and fluids are used to remove the pulp and debris that contaminate the deepest part of the teeth.

A dental apicoectomy, on the other hand, is performed in the periapical area – that is, around the outer part of the root. In this case, the infection located near the root portion of the tooth is cleaned and eliminated.

Both endodontics and a dental apicoectomy are conservative treatments. Both therapies seek to preserve the tooth in the mouth.

Anyway, as we will tell you here, a dental apicoectomy is used when traditional root canal treatments have failed. Let’s take a detailed look at when this procedure is indicated.

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The benefits of a dental apicoectomy

The main benefit of an apicoectomy is the possibility of preserving a tooth that has an infection and in which conventional root canal treatments have not worked. Preserving the tooth maintains the functionality and esthetics of the whole mouth, bringing well-being to the person.

Many times, despite having performed a root canal treatment, dental infections persist around the root. These processes can cause abscesses, cysts, or periapical granulomas.

This causes discomfort and pain in the area, swelling, fistulas, and bad breath. In addition, an infectious focus in the mouth can spread and cause more serious complications in the rest of the body.

If endodontics has not worked and the infection persists, a dental apicoectomy is an option that allows the tooth to be treated and preserved in the mouth. Otherwise, exodontia would be the less conservative solution.

Root canal treatments are sometimes not sufficient because the microorganisms present inside the tooth manage to resist the cleaning measures of this intervention. With a dental apicoectomy, on the other hand, the tip of the root and the infectious tissues around it are removed.

In any case, you should know that the dentist resorts to this procedure only when simpler methods, such as endodontics or root canal retreatments, have failed. It’s also often a useful alternative when the infected tooth has a cemented post and crown and its removal would jeopardize its integrity.

tools for dental apicoectomy
Endodontics may require an adjunct to apicoectomy to treat persistent infections.

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Contraindications of a dental apicoectomy

Just as there are cases in which the dentist recommends performing an apicoectomy, there are situations in which this procedure is not possible. These are some factors that contraindicate its application:

  • Very extensive root damage
  • Patients with coagulation problems
  • Acute infections with abundant bleeding
  • Tooth pieces with longitudinal fractures
  • The infection is in the proximity of the maxillary sinus
  • Teeth with false canals that can’t be treated with endodontics
  • Very advanced periodontal disease or much destruction of the supporting bone

In these cases, it will be necessary to extract the tooth and rehabilitate the absence with implants or some other prosthetic option.

How is a dental apicoectomy performed?

When planning a dental apicoectomy, the first step is to evaluate the condition of the endodontic tooth. It’s worth remembering that this intervention is performed on teeth that already have a root canal treatment that has failed.

To analyze the conditions of the tooth to be intervened, x-rays are taken, and the state of the root canal, the root apex, and the tissues that have reached the infection are evaluated. With these data, the dentist determines whether it is possible to perform surgery and plans the procedure.

The surgery is performed under local anesthesia in the area. Once the area is numb, a flap is made over the gum to access the region of the bone where the infection is.

Using specific instruments, a certain amount of bone tissue is removed to expose the end of the root. To do this, the dentist performs previous measurements that allow him o her to know exactly the area where he or she must intervene.

Once the dental apex is visualized, it’s then cut and extracted. That is, the tip of the tooth root is discarded. In addition, damaged tissues and infectious processes present in the area are removed.

To prevent leaks and future infections, the tooth canal is sealed with special materials. In addition, the site may be filled with antibacterial agents or bone grafts to promote tissue recovery.

In the end, the gum is repositioned in place and sutured. Over time, the tissues will regenerate and the area will regain its health.

Depending on the procedure and the complexity of the case, this type of treatment usually lasts between 30 and 90 minutes. Many dental offices have surgical microscopes that allow a more precise approach.

What does it feel like after the procedure?

Since this is a minor surgery, a dental apicoectomy doesn’t usually cause great discomfort to the patient. However, it involves a slower and more painful recovery than a root canal.

In the hours following surgery, the area may become swollen and painful when eating or talking. However, these are usually temporary discomforts that disappear after a few days.

The dentist prescribes anti-inflammatory drugs to control these symptoms and improve recovery. In addition, antibiotics are usually prescribed to help fight the existing infection and prevent complications.

The stitches are removed after a week, although they often come out on their own. It’s important for the patient to be gentle with the area, especially when brushing and flossing.

Oral care after a dental apicoectomy

While most patients are able to return to normal activities within a few days of a dental apicoectomy, there is some care that enhances recovery:

  • Maintain a soft and cold diet during the first days.
  • Apply cold to the operated area to reduce inflammation.
  • Clean and sanitize the mouth carefully and avoid brushing the operated area.
  • From the day after surgery, chlorhexidine rinses or gels can be used if recommended by your dentist.
  • Keep the head upright or raised to rest.
  • Do not engage in sports activities or physical exertion.
  • Avoid tobacco and alcohol consumption.

In addition, all instructions from the dentist should always be followed.

use ice for tooth pain after dental apicoectomy
Local cold will help reduce swelling faster after the procedure.

Risks and complications

Complications following dental apicoectomy are uncommon. In general, this is a highly successful procedure that reverses the symptoms and discomfort of tooth infection.

In fact, according to a 2020 study, about 97% of cases with apical surgeries experienced excellent results up to 5 years later. Good results continued in more than 75% of cases after 10 to 13 years.

A dental apicoectomy is considered to have failed if the infection persists, the area does not recover and symptoms are not relieved. In general, the cause of this failure usually refers to the presence of a space at the end of the root and a poor apical seal that favors the persistence and proliferation of bacteria.

If the procedure fails to solve the problem, then it will be necessary to resort to the extraction of the entire tooth.

A dental apicoectomy is an option to consider

A dental apicoectomy is an outpatient surgical treatment performed when conventional root canal treatment is not sufficient to save the tooth. With this treatment, it’s possible to keep the tooth in the mouth, which allows for chewing, speaking, and smiling normally.

Otherwise, the alternative to an apicoectomy is the extraction of the entire tooth. The loss of a tooth causes many functional and esthetic problems in the mouth and requires immediate rehabilitation to avoid complications.

Therefore, if your dentist recommends performing this type of surgery on the root tip, this is an option to consider. Not only will it treat and preserve the tooth, but it will also put an end to an infection that could spread and cause serious health problems.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

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This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.