Apical Root Dissection

When a tooth infection spreads down to the tip (apex) of the root, sometimes a standard root canal procedure is not enough to save the tooth, therefore an apicoectomy (apical root dissection) may be recommended. If your dentist has recommended an apical root dissection, this page can help educate you on what to expect during your procedure.

What Does “Apicoectomy” Mean?

Since an apicoectomy is not in the standard lexicon of dental words, you can be forgiven if the term sounds “Greek” to you, that’s because it is. As a term with its roots (no pun intended) in ancient Greek, the term is easier to understand when it is broken down into its individual components. Apico- originates from apek, meaning “tip.” So when you combine this with “-ectomy” (to cut off), the term apicoectomy translates to “cut off the tip.” There is actually a small canal at the tip of the tooth root known as the apical foramen. This is where the nerves and bloods vessels enter the tooth.

How are Apicoectomies Performed?

An apicoectomy is considered a minor surgical procedure. During a standard root canal treatment, the doctor drills through the crown of the tooth in order to clean out the pulp chamber and fill it with dental cement. With an apicoectomy, or ”apical root dissection,” the physician makes an incision through the gums in order to access and remove the affected root apex. Locating the apical root is not always easy; sometimes multiple X-rays or CT scans will need to be performed. To clean the narrow canal, the physician uses an ultrasonic instrument guided by a surgical microscope. Once the apical foramen is removed, the dissected root apex is sealed to prevent future infection and disease.

With the aid of modern technologies and precision instruments, apicoectomy procedures can be performed in as little as an hour. Before you leave, the staff will provide you with detailed instructions on caring for your wound.

Recovering from an Apicoectomy

Generally, your doctor will recommend that you keep a cold compress on the cheek over the surgical site for the next 12 hours. After 24 hours, bruising and swelling may become apparent. To help with the pain and swelling, you can take a nonsteroidal anti-inflammatory drug such as Motrin® or Advil®.

As you heal, try to avoid brushing the surgical site. Hard, crunchy foods should also be avoided as these have the potential to dislodge the stitches which can affect healing. Depending on your particular surgery, you will be scheduled to have your stitches removed anywhere from several days to a week following the procedure.

Why Do I Need an Apicoectomy?

The pulp chamber actually extends through the tooth root into narrow channels. When periodontal disease or decay reaches the apex (tip) of the root, sometimes the only option is to remove the affected area of the tooth — in this case, several millimeters of the apex.

There are numerous scenarios in which the apical foramen of the apex can become infected. These include age, trauma, or even changes in the composition of the root canals. In some cases, a condition known as an apical constriction can form. This usually occurs in teeth that have not yet fully matured and the apical foramen develops slowly or incorrectly.

Most patients who undergo an apical root dissection have had a previous root canal treatment performed on the tooth. Root canal treatments can sometimes fail to completely remove the disease and decay, allowing the disease to progress to the apical foramen.