Apicectomy: What is it? Indications, Limitations, Advantages, Disadvantages, Contraindications, Procedure and Risks

It is the most common treatment of canal surgery that is done to remove the tip or apex from the root of a tooth when it becomes infected.

Apicectomy is a type of endodontic microsurgery .

In this surgical practice a small part of the root of the tooth is removed, together with the surrounding soft tissue that may be infected.

It is possible that apicectomies also involve the removal of a cyst at the root of the tooth.

Indications

There are several reasons to perform an apicoectomy, among them we have:

  • When there is the impossibility of performing orthograde endodontic therapy due to the presence of pathological, anatomical or iatrogenic defects of the root canal.
  • The presence of an infection after an endodontic therapy.
  • When you have to do a biopsy.
  • When there is a need for an evaluation of the root apex to be sectioned or fractured.
  • To remove iatrogenic errors such as steps, fractured instruments and perforations that are not fulfilling their therapeutic function.
  • When there is a blockage of the root canal.
  • When you must remove a section of the root to the place where it integrates the material of the duct filling.
  • When necessary as a further stage in a preparation to perform a retrograde filling.

Limitations

Within the limitations that exist to perform an apicoectomy, we have:

  • The presence of systemic diseases.
  • The existence of an anatomical complexity, because the nerve, cortical and bony structures are very close with a lot of thickness.
  •  When there is a crown / root ratio, unfavorable.
  • When the treatment that has been indicated is to restore an endodontic therapy.

Advantage

In the treatment of apicoectomy there are certain advantages:

  • With apicoectomy a deep examination of the root apex and the environment can be performed.
  • An apical root canal with problems can be eliminated.
  • Removal of accessory canals at the root apex can be performed.

Disadvantages

An apicoectomy also has certain disadvantages, such as:

  • With apicoectomy, the length of the tooth root is cut.
  • The apical dentine is exposed since with the apicoectomy that is devoid of cement and this facilitates micro filtration at the apex.

Diagnosis

Before starting this type of procedure, the diagnosis is made by studying the images (radiographs) of the affected tooth and the surrounding bone.

The medical history is made by reviewing the type of medication the patient uses and the diseases he or she suffers.

Contraindications

  • Patients with blood disorders due to postoperative complications that may occur.
  • During pregnancy.
  • Patients presenting systemic diseases such as uncontrolled diabetes, chronic liver disease, chronic kidney disease, among others.
  • Patients with psychic illnesses.

Process

The apicoectomy is usually performed, with the application of a local anesthetic that numbs the tooth and adjacent gums, a small incision is made in the gum and the infection is checked at the apex end of the tooth root.

Usually a dye is used to check the cracks or fractures to suspend the apicectomy and extract the tooth at that moment.

Once the root of the tooth is checked, a microscope is used to examine the ducts for their tiny size.

The cleaning is performed, the tip of the root of the tooth is removed as well as the infected tissue together with a few millimeters from the tip of the root.

The canal of the tooth is filled with an inert material, sealed with a filling and preventing bacteria from entering the canal and causing infections.

To complete the procedure, a bone graft is placed in the affected site and finally, the gum is closed with suture.

Apicoectomies usually last between 30 and 90 minutes.

Post operatorio

The sutures usually disappear within the next two weeks, if the procedure is successful, in about six months the bones will replace the cavity from which the apex of the root or cyst was removed.

The area where the intervention was performed will feel sore and swelling may occur. In general, some antibiotics are prescribed for the prevention or treatment of any dental infection.

Likewise, analgesics and anti-inflammatories will be recommended.

To prevent infections inside the mouth it is necessary to keep the area clean, so antiseptic mouth rinses should be applied and very gentle brushing should be started on the teeth and gums.

It is also recommended to follow soft diets after the procedure.

Risks

The treatment of apicectomies performed on the upper part of your jaw can cause a negative impact on the paranasal sinuses .

Apicectomies performed on the posterior teeth of the lower jaw run the risk of nerve damage since the main nerves are located here.