Why would I need an Apicoectomy?


Usually conventional root canal therapy is all that is needed to save a tooth with an injured or infected pulp (the tissue inside the tooth which is usually referred to as the “nerve”). The pulp can become injured or infected due to trauma, a deep cavity, a crack in the tooth, or repeated dental procedures. Conventional root canal therapy is usually done through an access opening in the tooth itself by a general dentist or an endodontist (root canal specialist). Occasionally this non-surgical procedure will not be sufficient to remove all of the inflamed or necrotic pulp inside the tooth due to the complexity of the root canal system, especially in the last or “apical” one-third of the root. Many times there are areas of the root canal system that branch out laterally as you get toward the end of the root. These areas are not always amenable to treatment when working through the tooth alone. These uncleansed areas of the root canal system can lead to failure of conventional root canal therapy. Such failure may be manifested by pain, swelling, drainage through a fistula (bubble on the gum), or periapical infection in which the bone around the end of the root is replaced with a sack of infected tissue. The most common procedure used to treat failed conventional root canal therapy is an Apicoectomy, in which the “apex” or end of the root is removed. This surgery may also be referred to as Periapical Surgery or a Root-End Resection.

What is an Apicoectomy?

An Apicoectomy is a minor surgical procedure in which an incision is made to expose the bone lateral to the tooth, and a small window is made in that bone providing access to the end of the root. If the root is average in length, the last one-third of the root is resected since that is where most of the conventionally untreatable small branches of the root canal system reside. If present, the entire sack of infected tissue around the end of the root is then excised. The root surface is then inspected for cracks, fractures, untreated accessory canals, and anything which may be related to failure of the conventional root canal therapy. The root canals are then identified, prepared, and sealed under direct vision at the level of the root-end resection, and the incision is closed.