Apicoectomy: What to Know Before and After

An apicoectomy is a routine dental procedure with high success rates. You may experience minor discomfort and swelling immediately after surgery, but this typically lessens within a day or two.

An apicoectomy is a straightforward, minor surgical procedure that’s done on children and adults as a way to save at-risk teeth and prevent potentially serious complications.

An apicoectomy is also known as root end surgery. This is because it involves the removal of a tooth’s root tip and surrounding tissue. It’s also called apical surgery, which refers to the “apex,” or end, of the tooth.

If your dentist tells you that you need an apicoectomy, it’s probably because even though your tooth has already had a root canal, there’s residual inflammation or infection near the root tip that reaches into your jawbone.

An apicoectomy may be performed by a dentist, though it’s often handled by an endodontist. This is a type of dentist who specializes in root canal care.

Why it’s used

The procedure is usually recommended when a standard root canal treatment has already been performed on a tooth but isn’t sufficient to save the tooth and prevent further complications.

In cases where there’s an anatomical concern with the root tip, such as one root crowding into the space of the root next to it, an apicoectomy may be helpful in preventing problems that could affect multiple teeth later on.

If your dentist is recommending an apicoectomy, it’s because there’s no real alternative except removal of your entire tooth. In that event, you’d need an implant, bridge, or a removable partial denture to keep the nearby teeth from shifting.

Is it painful?

An apicoectomy can be more invasive than a typical root canal surgery, meaning the recovery time is usually more painful. Patients will receive local anesthesia during an apicoectomy to help prevent any pain.

Minor discomfort and swelling are normal after the procedure. A 2008 study found that postoperative pain usually decreased steadily during the first few days, with more than one-third of patients studied choosing not to take any pain medications.

Those patients who did take medication after an apicoectomy found adequate relief from over-the-counter pain relievers.

Here’s a breakdown of the procedure itself:

1. Before any work is done, you’ll be given a local anesthetic to numb the area around the affected tooth.
2. During the procedure, your dentist or endodontist cuts through your gum and pushes the gum tissue aside in order to reach the root. Usually just a few millimeters of the root are removed, as is any infected tissue surrounding the root.
3. After the root tip is removed, the root canal inside the tooth is cleaned and sealed with a small filling to prevent future infection. Your dentist or endodontist may then take another X-ray to make sure your tooth and jaw look good and that there are no spaces where a new infection could take hold.
4. The tissue will then be sutured (stitched), so your gum can heal and grow back in place. Your jawbone will also eventually heal around the filling at the end of the root. You shouldn’t feel much, if any, pain or discomfort during the procedure.

An apicoectomy usually takes 30 to 90 minutes. The location of the tooth and the intricacy of the root structure can affect the time needed to complete the surgery.

You may experience some minor discomfort and swelling once the anesthetic wears off. This gradually lessens over the next few days, though, and within a day or two, you should be able to resume normal activities.

Your doctor may prescribe antibiotics to help fight an existing infection or prevent a postoperative infection. For pain, anti-inflammatory medications such as ibuprofen should be sufficient.

Stitches are usually removed within a week. You’ll need to be careful brushing and flossing near the site of your surgery while the stitches are in place.