Teeth have roots that are anchored in place in the jaw bone. The tip of the root is called the apex. When a root canal is done,  the tooth is then cleaned of the infection. Sometimes after a root canal, debris and infection persist. This makes the tooth sensitive and the infection can spread from the tooth to the surrounding gingiva. When an apicoectomy is done, the tip of the tooth (apex) is removed along with the associated infection. A sealant is then completed at the tip of the root to prevent recurrence of infection.

If a tooth has had a root canal in the past and the infection came back, the problem is often located around the apex of the root. The maxillofacial surgeon can make a apicoectomy to fix the problem to prevent the tooth from being extracted. An apicoectomy is indicated only if the tooth has previously undergone a root canal treatment.

The most common reasons for failure of a root canal are:

– Teeth with unusual forms of roots

– Secondary root channels that can not be cleaned

– Cysts around the tooth

– A broken or cracked tooth

Although the root canal did not work, most of these teeth can be saved by a procedure called apicoectomy. During this surgery, the tip of the tooth or apex is removed and the infection therein is cleaned. If a cyst is present, we also remove it. An apicoectomy is a minor procedure performed in the clinic under local anesthesia with or without intravenous sedation by the maxillofacial surgeon. Once the site is healed, the tooth will be preserved for a long time.

The maxillofacial surgeon will review the risks of apectomy during the initial consultation. The main risk is that the apectomy does not work and the tooth must be extracted anyway. Depending on the position of the tooth, other risks are possible. When treating teeth on the back of the top jaw, the infection may involve the sinuses. The roots of the posterior teeth in the lower jaw are close to important nerve that may be affected by the surgery. Your surgeon will be guided by X-rays and 3D scans to determine the proximity of this nerve. The maxillofacial surgeon has the training and experience required to prevent these kinds of complications. The apicoectomy is usually a permanent solution for long term tooth preservation.

You will first meet your maxillofacial surgeon for a consultation before undergoing apectomy.  Also, your surgeon may take new X-rays of the tooth and gum around it. An anti-inflammatory or antibiotic medication you will be prescribed if necessary. Your medical history will be reviewed. Options for local anesthesia and intravenous sedation will be presented.

A soft diet is recommended during the first 2 days. You will need to apply ice over the treated area  during the 12 hours following the procedure. There may be swelling of the gum,  lip or cheek depending on the tooth treated. The swelling may be more important the second day after the surgery than the next day. Do not brush your teeth or rinse too vigorously at first. Smoking slows healing, so avoid smoking. The sutures themselves fall within 2 to 7 days. Pain and discomfort are usually completely gone after 2 weeks. Although apectomy is considered a surgery, most people find that the recovery is fairly easy.

Your maxillofacial surgeon will make a small incision on the gum to reach the root of the tooth. Infection will be removed as well as the tip of the tooth for (only a few milimeters). To complete the apicoectomy, the tip of the tooth is filled and sealed with a special cement in order to prevent recurrence of infection. Most apectomies take 30 to 45 minutes. The time required to complete the treatment depends on the shape and number of roots. Apectomies on the front teeth are the fastest and those on the teeth at the back of the jaw, especially the lower one, take longer to complete.