Apicoectomy/ Surgical Root Canal Treatment


Occasionally, a root canal procedure will not be sufficient to heal a tooth and surgery is required. The most common surgery used to save damaged teeth is called an apicoectomy or root-end resection. An apicoectomy procedure can be used to locate 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 particular type of procedure.


What is an Apicoectomy?


The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars usually have several roots; the front incisors only have a single root. The end or tip of each root is called the apex. The apex is where the nerves and blood vessels enter the tooth, and aid the delivery of blood to the crown (the part of the tooth you can see in your mouth).


A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection continues after the root canal treatment, an apicoectomy may be required. 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.  An apicoectomy is essentially a root canal but starting at the root instead of at the crown of the tooth. Possible removal of the apex (or root tip), followed by a filling procedure to seal the root to avoid further infection. When left untreated, infected roots may damage other teeth, spread infection, cause regression of the jawbone and possibly lead to the loss of the tooth.

 Following the procedure, there may be some discomfort or slight swelling while the incision takes time to heal. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be prescribed. If the pain persists, please call our office


Reasons for an apicoectomy


Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful at times to the patient. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicoectomy will be considered after a root canal treatment has failed.


There are several reasons why an apicoectomy may be necessary:


Small Adjoining Root Branches

Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.


Blocked Root Canal

Unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. Infection and debris can quickly affect adjacent teeth.


Narrow or Curved Root Canals

When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.


What does getting an apicoectomy involve?


Prior to the surgery, Dr. Eisner may prescribe an antibiotic to treat the underlying infection. X-rays will then be taken to enable Dr. Eisner to plan the apicoectomy, which will be performed either under local or IV anesthesia.


Dr. Eisner will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. He will then clean the surrounding infected tissue areas around the root to create a healthier environment for the treated tooth. The root will be sealed using a retrofill (filling material) and then he will suture the gum with several stitches.

After surgery we will prescribe pain medications. We will also schedule a post op appointment, and the connective tissues will fully heal several months after the procedure.


If you are experiencing any signs or symptoms, such as pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately to schedule an appointment.