Apicectomy - Catching The Root Problem
A root canal treatment is conducted by your dentist when the area of the pulp (where the blood vessels and nerves of your tooth) gets infected. The root canal treatment will remove the source of infection and all the infected matter within the tooth. However, the treatment will not be able to address any changes or infection that is present beyond the roots of the tooth.
In most cases, the infection present beyond the tooth gets reversed after the root canal treatment and healing takes place which will not necessitate any further treatment. However, in certain conditions this healing might not take place and the infection in this area continues to persist and flare up time and again.
In such conditions, the dentist will advise you to undertake a surgical procedure called apicectomy to help get rid of the problem.
So, what exactly is apicectomy?
Apicectomy is a surgical procedure where the dentist will reach out to the infected area around the root tips and will clear out any infection present in that area and will also correct any changes that are occurring in the surrounding bone. Also, if there is any incomplete root canal filling, the tip of the root will be sealed with a sealant that will prevent any further infection from occurring.
Indications for Apicectomy
Apicectomy is performed in many conditions but is usually conducted when symptoms persist even after the root canal procedure is completed. Some of the indications for apicectomy will include:
- Pain and persistence of signs of infection following root canal procedure.
- Severe curvature of the roots
- Incomplete root canal fillings
- Fractured roots of the tooth
- Calcification of the root preventing complete access till the root tips
- Bony changes in the area surrounding the root tip that need attention
- Perforation of the root
- Infection or cyst that cannot be corrected by conventional therapy.
Before undertaking the procedure, the dentist will take note of the symptoms and the history of the treatment already conducted. The dentist will then take appropriate x-rays to determine the changes in the bone.
When all the options including re-treatment through root canal therapy has been thought about and no other solution is at hand, the dentist might decide to go in for apicectomy.
Prior to undertaking the procedure, the dentist might put the patient on a course of antibiotics to keep infection under control. During the procedure, the area to be treated is anesthetized so that the patient will not feel any pain.
The gum around the tooth will be reflected to expose the bone around the tooth. Usually, bony changes around the tooth tip will make it easy to locate the area of infection around the tooth. If this is not the case, the dentist will access the area around the root tip by using the x-rays and other reference points.
Once the area of the root tip is reached, the canal of the tooth is accessed from below and cleaned with appropriate instruments and agents. Then the root canal is again sealed from below using a retrograde filling process. Once the root canal is sealed, then the area around the root tip is observed for bony changes and then appropriate measures are taken to prevent infection in this area and to stop the changes in the bone.
After the procedure is complete, the gums are positioned back and then sutures are placed to facilitate proper healing and the patient is put on antibiotics to prevent any recurrent infections.
The patient will have to follow instructions about post operative care to prevent failure of the procedure and to allow good healing to take place. Some of the care that might be advised to the patient will include:
- Diet and medication should be taken as advised by the dentist to facilitate proper healing and preventing infections.
- Ice packs might be advised by the dentist. This will promote clotting of the blood in the area and initiate healing procedure.
- The patient might be advised to avoid hot food stuffs and to avoid smoking for some days following the procedure or else healing might get disrupted.
- Usually no rest will be needed following the procedure and the patient can resume normal duties the very next day.
- Sutures placed will have to be removed a week after the procedure and the patient will have to return to the dentist to get this done.
- The healing might get disrupted if the patient tends to feel the treated area with the tongue or try to examine the area by lifting up the lips and this must be strictly avoided.
Complications and Risks
There are no major complications or risks involved in the procedure when done under the hands of an experienced dentist. However, even after undergoing the procedure sometimes the symptoms might continue to persist. In such a case, the patient will be advised to undergo extraction of the affected tooth.
During the procedure, if it is seen that the tooth has got severely damaged or fractured in the area of the roots, then extraction might be the only option. There is a possibility of causing damage to the nerves of the tooth when the procedure is performed on the back teeth.
Apicectomy is a surgical option that is followed when all other options of treatment in reducing the symptoms have failed. This is a safe and proven procedure that usually provides good relief with no recurrence of the symptoms.
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