Why would I need Endodontic Surgery? Generally, a root canal is all that is needed to save a tooth with an injured pulp from extraction. Occasionally, this non-surgical procedure (the root canal) will not be sufficient to heal the tooth and your Endodontist or general dentist will recommend endodontic surgery. The tip of the tooth root is called the apex; "ectomy" at the end of a word implies removing something. Therefore, an apicoectomy implies the surgical removal of the tip of the root of the problem tooth. A draining pimple in the gum above or below the tip of the root of a tooth reveals the infection from the dead nerve inside the tooth has spread beyond the tooth root and into the surrounding bone. This usually happens before root canal therapy is initiated and is resolved by removing the dead nerve. In rare situations, it will happen after a root canal and that suggests that an apicoectomy is needed. This surgical procedure can be used to locate root fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure.
What is an Apicoectomy?
During an apicoectomy, an incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function. Careful follow-up with dental x-rays and clinical examination is necessary to confirm that the proper healing that is expected has actually taken place. Your surgeon will schedule follow-up visits at one week, one month, six months and possibly one year after an apicoectomy is performed.
Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. Application of ice on and off of the affected side of the face every 20 minutes after surgery for the first 24 hours will help minimize the swelling. To alleviate any discomfort, you will be instructed to take 2-4 ibuprofen (Advil or Motrin), 2 aspirin, or 2 acetaminophen (Tylenol) every 4 hours after surgery. You will be given a prescription pain medication which can be taken in addition if needed. If you have pain that does not respond to medication, please call our office. You may also be given an antibiotic to help eliminate and/or prevent further infection in the area. The antibiotic should be taken until finished regardless of the presence of pain.
Surgical Instructions to Prepare for an Apicoectomy
This procedure is usually performed using local anesthesia. There are usually no restrictions after the procedure concerning driving or returning to work.
It is appropriate to eat a light meal and drink fluids before your surgical procedure unless you have elected an IV sedation or Nitrous Oxide/oxygen. In those cases, you must have an empty stomach for 6 hours before your procedure. You should also brush and floss after eating and prior to your arrival for your surgical appointment.
Continue all medications for blood pressure or thyroid problems and any other conditions as recommended by your physician. If you are a diabetic, you should ask your surgeon for special instructions about your pre-operative diet and how to take your insulin or oral hyperglycemic medicines. You will most likely be asked to stop blood thinners (Coumadin) at least three (3) days in advance of surgery. If there is a question, please call our office prior to your appointment.
If you have been advised by your physician or orthopedic surgeon to use antibiotic premedication because of mitral valve prolapse (MVP), heart murmur, artificial heart valve, total hip, total knee or other joint replacement, take your antibiotic one (1) hour before your surgery appointment. If there is a question, please call our office prior to your appointment.