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At Contemporary Endodontics, our Team of Houston Endodontists provides a wide range of Endodontic Dental Services, including Apicoectomy Treatment. Though it is certainly a feared and maligned dental procedure, root canal therapy is most often very successful, with over a 95% success rate. Root canal therapy is an effective treatment against infection of the pulp of the tooth — most of the time. Unfortunately, because of the way percentages work, this means that 5% of the time root canal therapy treatments fail. Though this is a small minority, it poses big problems for those affected. However, there is one last effort that can often be performed to salvage the tooth: an Apicoectomy.
If your dentist is recommending an apicoectomy, it means that your tooth cannot be successfully treated with a conventional root canal treatment (which will be described below). An apicoectomy is a minor surgical procedure in which the very tip of the tooth’s root is removed (“apico” – apex or end; “ectomy” – removal) and sealed. It is usually performed by an endodontist (“ENDO” – inside; “DONT” – tooth), a dentist who specializes in the diagnosis and treatment of tooth pain from root canal disease.
For those who are unfamiliar, below the surface of the gums, teeth are held in place by structures called roots. These roots often contain a complex system of blood vessels, nerves, and canals that run throughout the inner structure of the tooth. Though a root canal treatment is designed to flush out and disinfect the inner parts of the tooth, including these complex tunnel-like systems, sometimes some bacteria survive and re-infects the tooth. Often, the source of the problem is attributed to the root of the tooth, and in these cases, the root and any infected material might be removed without the necessity for complete removal of the tooth. In these cases, just the tip of the root may need to be removed to solve the problem; thus, an apicoectomy is performed.
Unlike traditional Root Canal Treatment, an apicoectomy is a surgical approach through the gum. After the area is thoroughly numbed with local anesthesia, a small incision is made through the gum tissues at the level of the affected root, permitting direct access to the infected periapical tissues (“PERI” – around; “APEX” – root end). This allows the removal of any inflamed or infected tissue near or around the tip of the root — along with a few millimeters of the root tip itself. A very small filling is then placed at the end of the root canal to seal the canal and prevent further infection. Afterward, a few sutures (stitches) are placed to assure that the gum tissues are closed and will heal properly. Where necessary, bone grafting or other techniques are used to help the bone to grow and fill back in, particularly if the infection has left a significant void. Over time, the absence of infection will allow the area to heal and return to normal function.
Endodontists use state-of-the-art technology such as fiber optic lights, operating microscopes, and ultrasonic instruments that clean via high-frequency vibration when performing endodontic surgery. These advanced technologies give endodontists a very accurate view of the tooth, making the treatment quick, comfortable, and successful.
So when should you consider an apicoectomy instead of a root canal therapy? Here are some reasons:
While only performed when conventional root canal retreatment is not practical, apicoectomy for failing root canal-treated teeth can save them, return the tooth, bone, and gum tissues to health for many years.