picectomy is an invasive dental procedure that involves the removal of the infected tip of a tooth root. In case of impossibility to treat the infection by simple root canal treatment , apicectomy proves to be the first line surgical operation to heal granulomas , cysts and dental abscesses .
Although relatively simple and almost painless, an apicoectomy operation still requires the qualification of the operator and the collaboration of the patient.
In the continuation of the article we will precisely describe all the phases of the apicectomy; subsequently, we will answer frequently asked questions and doubts in order to dispel, as much as possible, the typical pre-surgery tension.
Intervention
Apicectomy is a rather simple surgical procedure: after anesthetizing the diseased tooth , the infected mass can be removed from the apex of the root.
The main phases of the intervention are described below:
- After numbing the tooth under local anesthesia, the doctor makes an incision directly in the gum: in doing so, the underlying root is completely exposed
- The infected tissue is removed using special surgical instruments
- The last few millimeters of the root are removed (the root is left “uncovered”)
- The apicectomy proceeds with the meticulous disinfectionof the treated area to reduce the bacterial load: by doing so, it is possible to prevent further, possible infections
- The next step is the fillingof the root apex: the end of the root – whose tip has been removed – is sealed with a biocompatible material to deny access to bacteria . This operation is called retrograde sealing or obturation
- The apicectomy ends with the perfect repositioning of the gingival flaps: the gingiva must be sewn up with special stitches
Stitches that don’t undo will need to be removed by your doctor 2-7 days after surgery.
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Duration of the intervention
The duration of the operation generally varies from a minimum of half an hour to a maximum of 90 minutes, based on the tooth to be treated, the severity of the lesion and the complexity of the root structure of the tooth.
Risks and complications
Since it is a surgical operation, apicectomy can create discomfort or pain in the days following the operation. The most common symptoms reported by patients undergoing apicectomy are:
- Pain and swelling (more pronounced the day after the apicectomy)
- Numbness of the gum in the dental semi-arch where the operation was performed
- Chewing difficulties
- Gum bleeding
- Dental sensitivity
- Need to resort to tooth extractionin case of unsuccessful apicectomy
A non-negligible risk is the failure of the intervention: in case of failure, the only conceivable option to correct the error is the extraction of the tooth. The success of the intervention in the long term is essentially given by the specialist’s ability to perfectly seal the apex of the root, in order to guarantee a certain protection from possible bacterial attacks .
From here we understand how important it is to rely on expert and highly qualified doctors.
However, a perfectly performed apicectomy is usually a permanent solution.
After apicectomy
To speed up wound healing and minimize post-apectomy pain, the doctor will have to educate the patient on the correct behavior to adopt: the observance of some simple precautions can, without a doubt, favor a faster recovery, minimizing the appearance of complications.
The following are the general indications to observe after an apicectomy:
- To ease the pain when the anesthesia wears off, it is recommended to place an icepack (wrapped in a soft cotton cloth) on the outside of the jaw , in line with the surgery site.
- Regularly take anti-inflammatory drugs(e.g. ibuprofen ) in the 5-6 days after the apicectomy: the continuous administration of NSAIDs minimizes pain and reduces swelling in a short time. Ibuprofen (e.g. Brufen , Moment ) is particularly suitable for keeping pain at bay: it is advisable to take the drug by mouth at a dose of 200-400 mg (tablets, effervescent sachets) every 4-6 hours after meals, as needed. Do not take more than 2.4 grams per day.
- If necessary, take an antibioticas a precaution to reduce the risk of infection: follow the instructions given by your doctor. The antibiotic can only be taken with a doctor’s prescription.
- Gently rinse the mouth with disinfectant mouthwashes(e.g. chlorhexidine2%) only 12-24 hours after apicectomy. Continue rinsing for at least two weeks after surgery
- Follow a soft diet, consisting of soft foods such as purees, warm soups, smoothies, minced meat , homogenized foods , puddings , meatballs , boiled fish , etc.
- Observe absolute rest in the 2-3 days following the operation
- Do not vigorously brush the gum undergoing surgery to avoid injuring the still painful and swollen area. Prefer a soft bristle toothbrush; however, the use of the hydropulser is not recommended. .
- Do not lift the lip corresponding to the tooth subjected to apicectomy to avoid loosening the sutures made on the gum
After 6 months/one year from the apicectomy, the patient should undergo a radiographic control to verify the success of the dental operation in the long term. If even one year after the operation the conditions of the tooth that has undergone apicectomy are optimal from a conservative point of view, the chances that the granuloma will recur are extremely low. More generally, a perfectly successful apicectomy guarantees extraordinary (and permanent) coverage from apical infections in general.
