The last thing you probably want to hear from your dentist is, “Well, it looks like a root canal is in order.” A root canal is one of the most common and effective treatments used today to address infected or badly decayed teeth. Most patients see a positive change almost immediately after the surgery, but of course, no one looks forward to the procedure.

What happens if the root canal treatment doesn’t take care of the infected or decayed tooth though? If your dentist is unable to fully remove the infected pulp inside the tooth or the healing process after the root canal isn’t going as planned, an apicoectomy may be your best solution.

Why Would I Need an Apicoectomy?

To understand what happens during an apicoectomy, we need to first discuss the basic procedure of a root canal. In a root canal, the overriding goal is to eliminate infected or decayed tissue from underneath one or more teeth. Imagine that a tooth has roots, like a potted plant, and that they start within the tooth’s hollow section and branch out to find nourishment from within the gums. These “branches,” along with the pulpy matter within the teeth, can get infected and may require serious attention. Enter, the root canal.

The root canal process begins as the dentist creates a tiny hole in the side of the tooth that affords access to the infected tissues within. The decayed matter is removed through this small hole, and the root passages are then thoroughly cleaned to further minimize the effects of the infection. Depending on the nature of the infection, the dentist may introduce medication to the affected area. The roots may also be sealed off using a paste and a rubber-like compound called gutta-percha. The access hole that was initially created then gets filled to prevent any reinfection.

If the root canal doesn’t effectively eliminate the diseased tissues, an apicoectomy may be in order.

How Is the Apicoectomy Procedure Done?

Instead of creating a small hole in the side of the affected tooth, your dentist or oral surgeon will make a small incision on the gum line and move the flap of gum out of the way. This exposes the tooth and bone underneath the affected area and allows for easy removal of any remaining infected tissues. Your dentist may have to use a small drill to reach the infected parts of the root, but often they’re able to complete the process using the incision site.

The apicoectomy process refers to more than a simple “re-do” of the root canal’s disinfection process. Rather, the oral surgeon will complete a full cleaning and sealing of the end section of the tooth’s canal. They’ll also remove a minuscule amount of the root rip – often, just a millimeter or two.

This intricate process is what separates the apicoectomy from a standard root canal, as the root tip is sealed to minimize the chances of further infection. Because the area being worked on is so small, dentists will use specialized microscopes and lights to help guide their hands. The success of the procedure is reliant on the dentist removing all infected tissues and then thoroughly sealing off the specific parts of the tooth root that could cause problems down the road. While an apicoectomy is an outpatient procedure, it requires anywhere from 45 minutes to an hour and a half to complete. The lower molars are more challenging and time-consuming to complete while the upper or front teeth are quicker processes.

What Happens After the Apicoectomy?

Aftercare is incredibly important post-operation. Your oral surgeon will provide you with a list of medicines to take and an outline as to what you should and shouldn’t eat or drink. During the 12-hour period after the surgery, plan on icing the immediate area on a 20 minutes-on/2- minutes-off interval. Since you won’t be able to do a whole lot during your icing routine, take the opportunity to rest and relax. Watch a movie or get caught up on a series on TV. Or, simply lie down and enjoy the solitude.

Be prepared for some localized pain, bruising, or swelling after the surgery. You will have some minor pain on the day of the procedure, but most patients report that the second day is less comfortable than the first. The swelling will take some time to present. Your dentist will likely recommend an anti-inflammatory like Advil or Motrin, or you may be provided with a prescription for a more powerful pain medication. Numbness may present, too, so be aware that this is fairly common after the surgery. If it lasts more than a week or two, you’ll want to contact your dentist. Stitches that originally held your apicoectomy incision closed will either dissolve by themselves or will have to be removed a few days after the surgery.

Are There Risks Involved with an Apicoectomy?

Like any surgery, there are always going to be risks involved. But failing to address infections or decaying teeth in the mouth can lead to much more serious health complications down the road. During your initial consultation, ensure that you and your oral surgeon cover all of the possible risks and side effects of the apicoectomy.

Make sure you are clear regarding the reason you’re undergoing the surgery, and why the root canal wasn’t 100% effective. Most importantly, recognize that if the apicoectomy isn’t successful, you may have to have the tooth pulled.

Other risks related to the surgery include spreading the infection to nearby sinuses, in which case the dentist will likely prescribe an antibiotic and nasal decongestant to address the infection. Since the roots of some teeth are located close to nerve endings, surgery can cause nerve damage – though the odds of this happening are extremely small given today’s technological advances.

If you are currently experiencing pain or swelling from a tooth that has recently undergone a root canal, contact your dentist immediately. An apicoectomy will likely be the ideal solution to a root-level infection that cannot be cured by a traditional root canal procedure.