Apicoectomy is a surgical intervention that removes the granulation tissue present in the bone at the tip of the tooth’s root. In most cases, this disease is an infection that starts from the root of the tooth, being outlined in a cyst, that neglected, it can spread to other teeth or can break the bone mass.
Apical resection is indicated when there are:
– Anatomical difficulties that do not facilitate cleaning and proper root canal obturation
– Difficulties related to prosthetic rehabilitation of affected teeth
– Horizontal root fractures with apical necrosis
– Blockages on the length of root canal that can not be overcomed by endodontic treatment
– Procedural errors in endodontic treatment
– Periapical large lesions that can no longer be endodontically treated.
Apicoectomy’s success varies in consideration with the cause for what is performed.
Referring to failed endodontic treatments, retreatments are often not feasible or it can not achieve better results by classic endodontic treatment. If the causes of failure can not be established, the surgical approach is essential. In some cases, a periapical pathology requires surgical removal and biopsy is useful for identification.
If we refer to anatomical issues that do not help on achieving a correct endodontic treatment, they can be represented by root calcifications, severe curvature of roots or very narrow canals. When these anatomical aspects are not useful to a fair treatment, removal of the un-instrumented portion and sealing the remaining root abutment is the best solution.
Teeth with prosthetic restorations presenting periapical infections can be a difficulty when attempting endodontic retreatment. Ductal access may jeopardize the stability of the prosthetic crown. In case of the teeth that are restored with metal pins, the removal of the pins from canal can end with a fractured root. In this case apical resection of infected tissue and abutment sealing is the only conservative solution.
Channels may have remaining foreign bodies such as broken needles, restauratve materials, pieces of fractured pins. In such cases, the foreign bodies must be surgically removed along with a portion of the root.
Apicoectomy can be performed to all teeth, but the indication is guided by different anatomical varieties of roots in relation to the jaw bone surfaces and cavities reporting to nearby anatomy.
This operation is often performed in the dental office and do not involve the use of complex surgical instruments. Anesthesia is usually loco-regional or in some cases (anxious, difficult patients) can be performed general anesthesia. Either of the two methods of anesthesia is used, the procedure is painless.
Mucoperiosteal incision is carried out, soft tissue and periosteum is moved away and then is discovered the bone. Trepanation in realised on the bone and the affected bone is removed along with the dental apex.
The root canal is mechanically cleaned, washed and then sealed with a calibrated visible sealing. When permeability of the channel can not be achieved, sealant is applied to the remaining stump.
The suture is performed with nonabsorbable thread that will be removed after 6-7 days. After intervention teeth will be protected avoiding hard aliments and excessive chewing effort.
After surgery regional edema usually occurs within the first 24-48 hours, then it retreats. If edema persists, emphasizes, or if you experience pain several days post-operation, these symptoms highlight septic complications that are prevented by the dentist through appropriate medication.