Apicoectomy

What is an Apicoectomy?

If you have a root canal treated tooth but are still experiencing a toothache, another dental treatment is available to help relieve pain and save your tooth. In order to save the tooth, your dentist may recommend an apicoectomy, which is a minor dental surgery to remove the apex, or tip of the root of the tooth. 

There are several reasons why a root canal may fail and a tooth will require an apicoectomy to help repair the tooth as an alternative to a dental extraction. These reasons may include:

• Failed previous root canal
• Fracture of the tooth not disclosed in an x-ray
• Infected root or surrounding root tissue
• Hidden canals not previously root canaled
• Damaged root surface 
• Trauma to a previously root canaled tooth

Apicoectomy Procedure Steps

Your endodontist will take an x-ray or possibly a 3-D ConeBeam to get an accurate look at the tooth’s apex and all surrounding structures.

An apicoectomy resembles a root canal treatment in that you will need to have local anesthetic to not experience any discomfort. Isolation using a rubber dam or intraoral suction equipment will prevent contamination from saliva or blood. 

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A small incision will be made at the root's tip to remove any infected tissue and 3 to -4 millimeters of infected root tip structure.  A small piece of biocompatible filling will be used to seal the area and replace the few millimeters of the root tip.The gum is sutured (with stitches) and the bone will naturally heal to help restore the tooth's full function. At times, if the infection was severe and a significant amount of bone was removed, the endodontist will use a bone graft to help restore the area to avoid a large void at the root tip. 

What to Expect After an Apicoectomy

Similar to any minor dental surgery, there may be slight discomfort following the procedure. It is normal and expected to temporarily experience slight pain, swelling, bleeding or numbness. This pain can usually be managed by over-the-counter pain medication or a prescription from your dentist. 

You may use ice packs on the surgical site for up to 12 hours to minimize any swelling. Some endodontists will give an antibiotic if there was a significant infection. Most people can resume full activity the following day. 

You should follow your dentist’s post-surgical instructions and avoid the following to prevent infection to the surgical site:

• Smoking cigarettes or any type of nicotine products
• Brushing with pressure at the surgical site for several days 
• Vigorous rinsing can irritate the suture site
• Eating hard or crunchy foods until the site is healed
• Strenuous physical activity

What to Eat After an Apicoectomy

Your diet following an apicoectomy should consist of softer foods for the first few days to avoid disturbance of the surgical site. Good food options include pasta, rice, eggs, and soft chicken. Avoid eating hard or crunchy foods or drinking any hot beverage that may cause discomfort. 

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How Much Does an Apicoectomy Cost?

An apicoectomy can range in cost depending on the tooth treated, the endodontist treating you, your location, and your dental insurance coverage. Typically, the procedure will cost $1000 to $1500 without dental insurance. An apicoectomy procedure is costly, but when compared to the cost of a dental extraction and replacement of the tooth, it is an exceptional solution to restore your dental health. 

Common Questions

What is the difference between a root canal and an Apicoectomy?

A traditional root canal treats the infected tooth from the top of the tooth whereas an apicoectomy is a small surgical procedure at the tip of the root, or apex, of the tooth. A root canal will treat a tooth with deep tooth decay or trauma. The dentist will clean and disinfect and canals and seal the tooth from bacteria. An apicoectomy will remove a small piece of the root tip and clean any infected root tissue.

How do you know if you need an apicoectomy?

Your dentist will be able to determine if you need an apicoectomy by your clinical symptoms and an x-ray. If you had a previous root canal and the tooth is still causing discomfort or you have an infection, you may be a candidate for an apicoectomy. 

How painful is an apicoectomy?

An apicoectomy is no more painful than a conventional root canal. It is still expected to temporarily experience slight discomfort, swelling, bleeding, and numbness following the procedure.

How long does an apicoectomy take?

Typically an apicoectomy should take 30 to 90 minutes depending on the severity of the infection and the tooth treated. It is often the preparatory time for the surgery and not the actual surgery itself that is most time consuming.