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An apicoectomy is a minor surgical procedure performed to treat recurrent dental infections originating from the root canal. The area of surgery is near the tip of the roots of the teeth. The basic idea behind this surgery is to extend the life of a tooth by removing the infection around the root tip and then sealing the root opening, thereby creating conditions in which healing can take place.

Indications

Some of the situations which can require an Apicoectomy to be performed are:

  • The tooth did not respond to conventional root canal treatment
  • The presence of a draining sinus tract
  • The presence of a radiographic and clinically apparent periapical lesion such as a granuloma, abscess or cyst.
  • A tooth which shows evidence of external resorption.
  • A root canal treated tooth which has been over-filled and the protruding part is acting as a nidus of infection.
  • A fracture of the lower third portion of the root.
  • A broken endodontic instrument in the lower part of the tooth which cannot be bypassed or retrieved conventionally.

Procedure

While an Apicoectomy procedure can be performed by a general dentist who has had some special training with the procedure, it is usually referred to endodontists or oral surgeons.

Preoperative X-rays, including localized X-rays like peri-apical views as well as full mouth X-rays like OPGs, will be taken preoperatively.

Once the extent of the lesion has been determined, the surgeon will have an outline of the surgical extent in the mind. A preoperative rinse with chlorhexidine is usually given to the patient.

The procedure is performed under local anesthesia.

After adequate anesthesia has been achieved, the surgeon will use a surgical scalpel to make incisions along the planned surgical outline. The incisions are deep enough to hit the bone so that a full thickness flap can be reflected.

A periosteal elevator will be used to uncover the underlying bone as well as the lesion. The surgeon will take care to ensure that the flap has adequate blood flow throughout the procedure. A wider base and only reflecting as much tissue as necessary will help in that respect.

Once access to the root tip and the surrounding perapical lesion has been achieved, the process of removing the infected tissue will begin. Any cyst or granuloma that is present will be excised completely. The window of bone that remains afterwards should not be bleeding profusely and be bereft of any dead or decaying tissue.

The root tip is then sectioned off with the help of a bur and a retrograde filling is placed. Once this has been done, the process of suturing the surgical site will begin.

The entire process should not take more than half an hour to forty five minutes.

For the patient, the entire procedure is painless and only the local anesthesia injections are felt. After that, there is no pain whatsoever during the procedure, however a little amount of pressure might be felt.

Conclusion

An apicoectomy procedure is a relatively minor surgical procedure that can help alleviate long-term symptoms in patients without causing too much discomfort.

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