Apicoectomy is the process through which the root tip and its surrounding infected issues of an infected tooth is removed. Generally, this procedure is done when inflammation or infection persists after a root canal treatment. This process is also known as endodontic microsurgery because the procedure is performed under an operating microscope. The other name for it also is Root-End Resection.
If after a root canal treatment, a root canal again becomes infected, most of the time it happens because of a problem near the apex of the root. The dentist uses this procedure so that he can fix the problem so that the tooth does not need to be extracted out. This process is done only after at least one root canal procedure.
Some of the cases, it is possible that before an apicoectomy is done, a second root canal treatment is done. After so much of advancement in technology, it has become possible for the dentists that they can easily detect those canals, which were properly treated. This the time when a doing a second root canal procedure becomes the option instead of an apicoectomy.
This process must not be understood as being same to a root resection , where an entire root is removed instead of the tip.
The surgeon cuts and the lifts the gum away from the tooth so that the root becomes accessible. The infected tissue is then removed along with the tip of the root. Here a dye is used to highlight the cracks and fractures in the tooth as if there is any such problem, then the tooth needs to be extracted and apicoectomy is not done.
In an apicoectomy, around 3 - 4 millimeters of the canal of the tooth is cleaned (done under a microscope using ultrasonic instruments) and then sealed. When the microscope is used, the chances of success are increased due to good visibility of the area. Then an X-ray of the area is taken before the tissue is put back.
The procedure generally takes between 30 to 90 minutes, but it depends on the location of the tooth and also the complexity of the structure of the root. The front teeth take less time in comparison to the lower molars that takes maximum time.
The patient gets instructions about medications and eating/drinking. After 10-12 hours of the surgery, one needs to ice the area as there may be swelling and bruise and take relax for the rest of the day. Any pain or swelling on the second day can be controlled with nonsteroidal anti-inflammatory drugs available at the chemist or prescribed by the dentist.
Avoid brushing the area or vigorous, smoking, eating crunchy or hard foods. Do not try to examine the area on your own as it might prove to be harmful. The area might be numb for about a week after the surgery.
The stitches are removed in 2 to 7 days after the process, and the swelling generally goes in around 15 days. The recovery is speedy and easy in most of the cases.
If even after a root canal treatment, you feel any pain or swelling in the particular tooth, you must call the dentist. He might then take X-rays and examine you. Only after this, the requirement of an apicoectomy is decided.
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