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The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars tend to have several roots, whereas the incisors only have a single root. The end or tip of each root is termed the apex. The apex is where the nerves and blood vessels enter the tooth and aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).
A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause resorption of the jawbone.
Reasons for an apicoectomy
Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicoectomy will rarely be considered by the surgeon unless a prior root canal treatment has failed.
There are several reasons why an apicoectomy may be necessary:
Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
Blocked Root Canal – In some cases, a root canal cannot be effectively cleaned because it is blocked by a fractured file left behind from prior root canal treatment. In addition, some root canals may be calcified, making it impossible to instrument the canal. An apicoectomy allows for elimination of the infected tissue from the apex of the tooth.
Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.