Apicectomy is the surgical practice of first choice for the treatment of non-curable dental granulomas through simple devitalization (canal filling).
Precisely, apicectomy involves two basic steps:
- Removal of the apex of a tooth root severely infected with bacteria
- Filling the open root cavity with a biocompatible material ( retrograde dental sealing )
Terminology
- Dental granuloma: chronic inflammationof the root apex of a tooth
- Dental root: section of the tooth inserted into the alveolar bone, which contains the dental pulp(the vital part of a tooth)
- Root apex: The point from which nervesand blood vessels enter the tooth
- Root canal: the canaliculus within the root, in which nerve fibers and blood vessels flow
Apicectomy is mainly performed to permanently seal the root canal from the apex, denying any possible access to bacteria.
Although it is a rather invasive operation, apicectomy is not particularly painful and must always be performed under local anesthesia.
Why are you running?
Performed in extremely serious conditions, apicectomy is aimed at treating important chronic inflammations at the root apex level of a tooth (e.g. granulomas) and dental abscesses .
To heal completely, a granuloma requires surgical treatment: usually, the root canal is sufficient to completely remove the infection . However, the granuloma must undergo apicectomy when the tooth – for anatomical or pathological reasons – cannot be devitalized.
From Wikipedia: the various stages of dental root canal treatment. A) Diseased or damaged tooth. B) Drilling and cleaning. C) Elimination of vessels and nerves up to the apex of the tooth with root canal files (“files” endodontic). D) filling with gutta-percha and covering with prosthetic crown (capsule)
A diseased tooth cannot be root canalized under the following circumstances:
- The infected tooth has already been devitalised and cannot be re-treated
- The root canal of the damaged tooth is blocked by a non-removable post
- Inability to reach the root canal with the surgical instruments normally used during a root canal
- The tooth affected by the granuloma is encapsulated
- Very tortuous and curved root canal
The only alternative to root canal treatment for granulomas is therefore apicectomy. Only in extremely serious cases, where the infected tooth cannot be treated either with apicectomy or even less with devitalization, dental extraction proves to be the only (and extreme) conceivable solution.
The various phases of Apicectomy: 1) gingival incision to discover the dental root affected by granuloma 2) and 3) removal of the infected tissue 4) removal of the root apex 5) filling of the root canal 6) repositioning of the gingival flaps
Directions
In addition to the treatment of dental granulomas and abscesses , apicectomy can be performed in case of:
- Breakage/severe trauma to the root of a tooth
- Dental cysts
- Root perforation
- Unbearable toothachethat cannot be treated with other endodontic treatments
- Persistent dental symptoms that do not indicate any morbid phenomenon on X-rays
On which teeth can it be performed?
Contrary to popular belief, apicectomy can be performed on both front teeth and molars. Clearly, such an operation performed on incisors or canines is faster and more expeditious because the teeth have only one root canal. On the other hand, apicectomy operations in molars present a higher difficulty due to the higher number of root canals.
If the tooth affected by the granuloma is a wisdom tooth , extraction is recommended .
Is apicectomy painful?
The apicectomy surgery is performed on an outpatient basis, under local anesthesia. Thanks to the refinement of anesthetic procedures, the removal of the granuloma by apicectomy is almost painless. Clearly, since it is still a surgical intervention, in the days following the intervention the tooth can be more sensitive than the other healthy teeth, especially to sudden changes in temperature.
Preparation for apicectomy
Before apicectomy, consultation and specialist visit with your trusted dentist are inevitable. To establish whether or not the apicectomy is necessary, the doctor will have to ascertain the state of health of the tooth and carefully evaluate the lesion with the aid of radiographic studies (X-rays) .
The doctor’s duty is to explain to the patient what exactly the procedure consists of, making him aware of the possible risks and complications.
It is recommended to always inform the doctor in the presence of allergies to drugs or materials (eg allergy to latex , allergy to nickel ), illnesses (past or in progress) and a possible pregnancy (presumed or in progress). Furthermore, it is equally important to tell your dentist if you are taking any medicines to treat a certain disease.
A few days before the apicectomy, the patient should follow a precise precautionary scheme to minimize post-operative risks.
Below are the standard guidelines to practice before the operation:
- Support the normal cleaning of the oral cavitywith rinses of medicated mouthwashes with a disinfectant action (e.g. chlorhexidine ). Start the treatment 3-4 days before the apicectomy
- Taking an antibioticone day (or two days before) the apicectomy can prevent any infections in the immediate post-surgery. The antibiotic requires a prescription
- Take an anti-inflammatorydrug at least a couple of hours before undergoing the apicectomy: this advice can help reduce pain and inflammation that arise after the procedure, as soon as the anesthesia wears off
Before proceeding with the apicectomy, it is necessary – as well as indispensable – to always address all doubts, worries and uncertainties to the dentist.
