Apicoectomy

Oral surgery Norwood, MA | Mansfield, MA

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Usually, a root canal, post, and crown are all that are required to save infected or abscessed teeth. Occasionally, a non-surgical root canal procedure will not be sufficient to heal the tooth and your general dentist or endodontist will recommend surgery.

The most common causes for root canal failure are:

Recurrent infection at the tip (apex) of the root; may be due to small accessory canals. Accessory canals usually cannot be seen on dental radiographs and often cannot be treated by conventional root canal therapy. Persistent bacterial infection in the surrounding apical tissue at the root tip can also cause recurrent infection.

Fracture of the tooth root; there may be a very fine hair-line fracture in the root of the tooth that may not show up on dental radiograph. Root fractures can be difficult to diagnose. If a root fracture is present, nothing can save the tooth, it must be extracted.

What is an Apicoectomy?

Apicoectomy to treat infection at the tooth's root tip

The above diagram illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. A small window is created in the bone in the region of the root apex (tip of the root). Damaged, infected tissue in the bone around the root tip is removed. The tip of the root is removed and a small preparation is made in the root to receive an amalgam (silver) filling.

The amalgam filling (retrograde amalgam) is placed at the tip of the root to seal the canal and prevent re-infection of the surrounding bone. The gum is sutured with small dissolvable sutures. The bone heals around the root, restoring full function.

An apicoectomy can be accomplished comfortably in our office with any one of the following anesthetic techniques: local anesthesia, intravenous general anesthesia, intravenous conscious sedation, nitrous oxide anesthesia or oral sedation with local anesthesia. Dr Turesky will help you to select the anesthetic technique best suited for your needs during your consultation visit.

When conventional root canal treatment fails there are three treatment options available:

  • Attempt to retreat the root canal (this often has a poor prognosis).
  • Perform a surgical root canal (apicoectomy with retrograde amalgam).
  • Extract the tooth.