Apical Microsurgery / Apicectomy
When and Why do I need Apical Surgery?
Endodontic microsurgery is usually needed when the tooth does not heal as expected after initial root canal treatment or root canal retreatment.
Other reasons for Apical surgery are when a patient has either new crowns or bridges, or full arch restorations making dismantling of the prosthesis either very expensive or would limit the longevity of the restoration.
In some cases, root canal treatment is insufficient to save your tooth. In such a situation, your endodontist may recommend alternative strategies, which may include endodontic microsurgery. The endodontic microsurgery is a surgical procedure performed under microscope that allows the dentist to access part of the root or the tip which would not be possible with conventional treatment methods.
After conventional root treatment or Re-treatment a tooth may fail to heal for several reasons. There are many situations in which endodontic surgery can help save your tooth where normal root canal therapy would be lacking:
- Surgery may be used for extensive diagnosis. Some patients have recurring symptoms, but no visible problems appear on their X-rays. These cases can sometimes indicate a tiny fracture or break in the tooth structure or root that could not be detected during nonsurgical treatment. In such cases, endodontic microsurgery can give your endodontist a chance to thoroughly examine the tooth’s structure without relying on X-rays,find the problem and provide treatment or even confirmation of an untreatable condition.
- In some cases, protective dentine deposits may make a canal too narrow for the cleaning and shaping ( Pulp Canal Obliteration)
- Blockages, ledges and fractured instruments instruments may prevent the endodontist from reaching the end of the root of the tooth, therefore preventing adequate cleaning protocols
- In some cases, a tooth may fail to heal after successful root canal treatment or retreatment. Symptoms or problems may persist, or reoccur later. This maybe due to extra-radicular infection or non endodontic pathology
Most infections at the end of the tooth that do not resolve are due to missed anatomy, blockages and ledges or infection that cannot be accessed from within the tooth. Removal of the infection beyond the tooth and resection of 3-4mm of root tip remove >90% of the causative factors
What is Involved in Apical Surgery?
We use local anesthesia in your tooth area and only start the treatment when we are sure you are fully numb.
With the help of a dental microscope we locate the underlying bone through a window in the gum near the area and remove any inflamed and infected tissue.
The very end 3-4mm of the root is also removed. Special Ultrasonic instruments are used to clean out the inside of the canal upto 9mm in length to remove either the root canal filling material, a ledge or broken instrument. The internals of the root can then be cleaned and prepared for a retrograde filling.
The tip of the root is then dried and filled with a bioceramic sealer and putty to occlude and seal the end of the root. This material is completely biocompatible and allows for increased rates of bony healing and ligament formation.
The small access flap is placed back, compressed with damp gauze to allow for better adaption of the soft tissue. Multiple very fine sutures are placed to hold the surgical area still and allow for healing.
Post operatively we usually provide Ice Packs to reduce swelling and advise the use of pain killers such as Paracetamol and anti-inflammatories such as Ibuprofen.
Gentle brushing and Hot salty Mouth washes will keep the area clean and reduce the risk of infection.
Sutures are usually removed at approximately 5 days.
In many cases, the only alternative to endodontic surgery is the removal (or extraction) of the tooth. After this procedure, the tooth must be replaced with an artificial replacement – an implant, bridge or denture – to restore the tooth’s function and to prevent the surrounding teeth from moving. These alternatives usually require surgery or procedures on adjacent healthy teeth, which means that endodontic surgery is not only cost-effective, it is the most natural and least destructive.
What do I do prior to my RCT appointment?
- If you are on any medication please do not stop any of these unless advised by your GP or endodontist
- Please visit the lavatory prior to treatment.
- Please ensure that you have eaten prior to treatment if you are diabetic
- Please wear something comfortable
- Please do NOT wear expensive or personally important clothing due to the use of bleaching chemicals
- Please bring with you any EpiPens, GTN sprays, inhalers
- Please feel free to bring headphones, blankets and moral support if this will help you relax
- IF you are in pain prior to treatment please take any normal painkillers as this will help with the ability to numb you up
What happens at the appointment?
- The patient will be guided through consent and the procedure
- Please inform us if you are diabetic, as we can numb you up in such a way that your tongue and lips will NOT feel numb postopratively
- The patient will be anesthetised and pulpal numbness confirmed
- The patient will receive a rubber dam ( which is a sheet of non latex rubber) over the tooth to be treated to protect their airway from any accidental swallowing of instruments and cleaning agents.
- The tooth will be root treated in 1 visit or dressed with a medication ( for varying reasons) prior to a 2nd visit to finish treatment.
- The tooth will be sealed with most commonly a white composite filling ready to be restored by their dentist. This increases the long term outcome and ensures that the dentist does not have to disturb any of our work
What happens after the appointment?
- You will be sent back with a permanent filling in the tooth concerned.
- You will be referred BACK to YOUR dentist on completion of treatment
- Your dentist will receive a letter explaining the diagnosis, treatment and follow up procedures required.
- YOUR DENTIST will provide any necessary post operative crown or onlay
- You will receive a post operative phonecall to monitor how you are doing after treatment.
- You will receive a post operative review appointment (s) as required
Guidance AFTER root canal treatment
- If you have had conventional dental anaesthesia please DO NOT eat or drink anything hot until all numbness has resolved
- Please take anti-inflammatory pain killers for at least 72 hours
- The tooth will normally be taken out of the bite to aid healing especially if it was painful to bite on
- Please keep the gum margin clean, as the rubber dam clamp can traumatise the gum and ulcerate it
- Please keep the tooth clean with interproximal brushes ( Tepes, Curaprox), interdental brushes as you maybe more likely to have food trapping. This can give you a low grade dull ache and tenderness to bite.
- IF you have any concerns regarding pain, swelling please contact the practice directly
- IF you have had swelling or incision and drainage please use hot saltly mouthwashes as often as possible to aid healing.
- Avoid heavy loading of the root treated tooth until your dentist has permanently restored the tooth
- Once all signs and symptoms have resolved please contact your dentist ASAP to plan for protection of the root treated tooth