Apicoectomy, also known as root-end resection or root-end surgery, is a dental surgical procedure performed to remove the tip of the tooth’s root (apex) and any infected tissue surrounding it. This procedure is typically indicated when a conventional root canal treatment has failed to resolve persistent infection or inflammation in the root canal system of a tooth.

Here’s an overview of the apicoectomy procedure:

1. Indications:

• Apicoectomy is indicated when a tooth that has undergone root canal treatment continues to exhibit signs of infection, inflammation, or persistent symptoms such as pain, swelling, or drainage.
• Common reasons for apicoectomy include the presence of infection or inflammation in the root canal system that cannot be resolved with conventional root canal therapy, persistent periapical lesions (abscesses), or the presence of accessory canals or anatomical complexities that cannot be adequately treated with nonsurgical means.

1. Preoperative Assessment:

• Before performing an apicoectomy, the dentist or endodontist will conduct a comprehensive evaluation of the affected tooth, including clinical examination, radiographic assessment (X-rays), and possibly additional diagnostic tests such as pulp vitality testing or cone-beam computed tomography (CBCT).
• The goal of the preoperative assessment is to identify the cause of the persistent infection or inflammation and determine the suitability of apicoectomy as a treatment option.

1. Procedure:

• Anesthesia: Local anesthesia is administered to numb the area surrounding the affected tooth and ensure the patient’s comfort during the procedure.
• Tooth isolation: The tooth and surrounding area are isolated using a dental dam or other protective barrier to maintain a clean and sterile field.
• Access: The dentist or endodontist makes a small incision in the gum tissue near the apex of the tooth to access the underlying bone and root tip.
• Root-end resection: Using specialized dental instruments, the dentist or endodontist removes the tip of the tooth’s root (apex) along with any infected or inflamed tissue.
• Root-end preparation: The root canal(s) of the tooth may be cleaned, shaped, and filled with a biocompatible material to seal the root canal space and prevent recontamination or reinfection.
• Root-end sealing: A small filling material (such as gutta-percha) is placed in the prepared root canal space, and a root-end filling material (such as mineral trioxide aggregate or dental cement) is used to seal the root-end cavity.
• Suture placement: The gum tissue is repositioned and sutured back into place to facilitate healing.

1. Postoperative Care:

• Following the procedure, the patient may experience some discomfort, swelling, or bruising, which can be managed with pain medication and cold compresses applied to the outside of the cheek.
• Patients are advised to follow postoperative instructions provided by the dentist or endodontist, including dietary restrictions, oral hygiene practices, and any prescribed medications.
• Regular follow-up appointments are scheduled to monitor healing, assess the success of the procedure, and address any concerns or complications.

1. Prognosis:

• The success of apicoectomy depends on various factors, including the extent of infection or inflammation, the quality of the root-end preparation and sealing, and the patient’s oral hygiene and compliance with postoperative care instructions.
• With proper care and maintenance, apicoectomy can provide a favorable outcome, relieving symptoms and preserving the affected tooth for long-term function and aesthetics.

In summary, apicoectomy is a dental surgical procedure performed to remove the tip of a tooth’s root (apex) and any infected tissue surrounding it, typically indicated when conventional root canal treatment has failed to resolve persistent infection or inflammation. If you have a tooth that may require apicoectomy or if you have any questions about the procedure, it’s important to consult with your dentist or endodontist for a thorough evaluation and personalized treatment plan.