Last week I encountered with a patient who had persistent pain and discharge from lower first molar from almost a year. Upon taking the history, we came to know that he had undergone an RCT and crowning over it. I took an X ray and saw an opaque thing which was later diagnosed as an abscess. I had two options. Either to go for tooth extraction or to start with Apicectomy and I choose the later one. So, let us see what Apicectomy is and how it can safe a tooth.
Apicectomy is a combination of words “apex” and “ectomy” which means surgical removal of the tip of the tooth root. Many a times, students are confused between Apicectomy and hemisectomy. Hemisectomy is the complete removal of the root where as Apicectomy is just the removal of tooth root. The main reason to undergo Apicectomy is to prevent the infection or abscess underneath the tooth and thus preventing tooth extraction.
Apicectomy is also termed as root end surgery or endodontic microsurgery.
Let us see what the conditions are when you have to undergo for an Apicectomy.
Root Canal Failure: In case of RCT failure cases, the first thing recommended is to visit an endodontist to have re RCT done but if the infection is still there and can spread to adjacent tissue then only Apicectomy is prescribed.
File broken: While performing the root canal, dentist sometimes break the canals inside the root and that might pose a threat to the case.
Calcified root canal: Sometimes while performing RCT, there is ledge formation due to deposits of shavings of root canal that might lead to future calcification. This may also lead to Apicectomy.
Continuous pathological changes in the tooth root that have the chances of getting spread to the adjacent teeth or oral areas.
Uncleaned root canals that causes infection in future.
Apicectomy procedure is divided into three stages: Pre surgery, Surgery and post surgery.
Pre surgery stage
During this stage, endodontist or an oral and maxillofacial surgeon will prescribe you with NSAIDS (Non Stimulatory Anti Inflammatory Drugs) and will take up your X rays to see the abscess invasion. You will be asked to do mouth wash rinses prior to the surgery. After that a complete history will be taken.
Depending upon the tooth, Local Anesthesia will be injected into the site. After the area shows sign of numbness, an incision will be given to lift the gums and alveolar bone and thus the infection root is completely exposed. In order to obtain high rate of success and precision, microscope is generally used and hence Apicectomy is also called “endodontic microsurgery”.
After cleaning the complete root and thorough suctioning, the infected root tip is removed along with the adjoining infected tissues. Retro filling is done using a biocompatible material to seal the opened root.
After surgery, final suturing is done using dissolvable silk sutures. The whole procedure usually takes around one to one and a half hour of time but lower molars generally consume more time due to thick alveolar bone.
Post Surgery stage
After the surgery you need to follow some set of instructions like:
Applying ice over the surgical site for 20 minutes on and 20 minutes off. This should be continued for one full day after the surgery.
You can take over the counter drugs to reduce any post operative swelling. E.g. Ibuprofen.
Don’t brush in the surgical site. After every meals gargle gently with Luke warm water.
Don’t poke the area or lift the lips. This can damage the sutures and impair healing process.
Avoid any spicy or chewy food for at least a week. Keep yourself restricted to liquid diet.
Take adequate rest for couple of days after surgery.
If you will take care of the post operative instruction, you will recover completely in couple of weeks.
The cost of Apicectomy is generally higher due to the following reasons:
It is only treated by specialized endodontist or oral surgeons.
It requires a great deal of precision.
It is a case of RCT failure.
Depending upon these things, it can vary from $900 to $1,300 without dental insurance and $100 to $500 with dental insurance.
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