Apicoectomy, or surgical endodontic therapy
is needed when a tooth remains symptomatic, or proper healing doesn’t
occur. Most often, these teeth require retreatment. Some teeth
are not good candidates for retreatment, and are instead treated
with an apicoectomy. This procedure is a “reverse” root
canal, when treatment addresses the end of the roots instead of
the top of the tooth. Many times it is not possible to reach the
infection because of calcification or constriction of the root
canal space, previous root canal filling, or type of permanent
restoration.
This procedure is performed with local anesthetic, and takes about
as long as a conventional non-surgical root canal. An incision
is made in the gum tissue beneath the tooth to expose the root
tip area. The infected tissue is removed and special retrograde
fillings are placed to seal the root canal space. Sutures are then
placed to stabilize the gum tissue for a few days until healing
takes place. The soft gum tissues heal within a few days, and bone
should regenerate and heal the defect where the infection was.
This will be confirmed with a follow up visit several months later.
This is a very predictable treatment, and most patients tolerate
it quite easily.
Swelling, minor pain, slight bleeding, and/or skin discoloration
may be experienced. This will be temporary. If surgery was performed
in the lower jaw, tingling of the lower lip is possible due to
stretching the nerve supplying this area.
Please take pain medication as soon as you arrive home, as it is
easier to prevent pain than to stop pain once it has started. If
the medication prescribed doesn’t help or you have an adverse
reaction, please contact our office so that we may alter the medication
as necessary.
In order to keep swelling to a minimum, use of a cold compress
on the face over the surgical site is recommended. The cold compress
will constrict blood flow slightly, and should be used alternately
20 minutes on and off for up to 48 hours after surgery. This will
prevent swelling, reduce bruising, and relieve temporary throbbing
and aching.
Keep your head elevated for the first two nights after surgery
to reduce swelling.
Do not pull your lip with your fingers to inspect the area. This
may dislodge the sutures or cause additional swelling. Sutures
will be removed after several days, or dissolve after 4-5 days.
If non-dissolving sutures were placed, an appointment will be made
for you to come back to our office for removal.
Get plenty of rest and ensure normal intake of foods and liquids.
Avoid smoking and alcohol. Avoid hot, chewy, or hard foods for
a couple of days. Brush your teeth, but avoid the surgical site
for 24 hours. The incision will heal very quickly, but the gum
tissue can swell further and bruise if is reinjured.
Gently rinse your mouth with tap water the first day of the surgery.
After about 24 hours, switch to warm salt rinses and continue for
a couple of days.
Swelling and slight discomfort are normal, and should start to subside
after a few days. If the swelling or bruising appears to worsen
after 2-3 days, resume the cold compresses and contact our office.
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