Apicectomy (apical surgery)

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An apicectomy or root surgery is when a small part of the tooth’s root is removed surgically and the surrounding soft tissue that is infected is removed.

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

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

• There is the impossibility of performing orthograde endodontic therapy due to pathological, anatomical, or iatrogenic defects of the root canal.
• The presence of infection after endodontic treatment.
• When you have to do a biopsy.
• There is a need to evaluate whether the root apex is 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 preparation to perform a retrograde filling.

Within the limitations that exist to performing an apicectomy, we have:

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

In the treatment of apicectomy, there are certain advantages: 

• Deep examination of the root apex and the environment can be performed with an apicoectomy.
• An apical root canal with problems can be eliminated.
• Removal of accessory canals at the root apex can be achieved.

An apicectomy also has certain disadvantages, such as:

• With apicoectomy, the length of the tooth root is cut.
• The apical dentine is exposed to the apicoectomy devoid of cement, which facilitates microfiltration at the apex.

Before starting this procedure, the diagnosis is made by studying the images (radiographs or scans) 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 they suffer.

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

• 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. Some antibiotics are prescribed to prevent or treat any dental infection.
• Likewise, analgesics and anti-inflammatories will be recommended.
• It is necessary to keep the area clean to prevent infections inside the mouth, 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 a soft diet after the procedure.