An apicectomy is a surgical procedure in which the root-tip of a tooth is removed and the truncated root- tip is hermetically sealed with a root-filling.
An apicectomy (also known as surgical endodontics, apical surgery or peri-radicular surgery) should be considered only when conventional endodontic root filling (‘root canal treatment’) techniques have failed.
A conventional endodontic treatment is indicated if the dental pulp (‘nerve’) of a tooth becomes non-vital (dies) or is likely to be put at risk due to the type or size of restoration needed to repair the tooth.
During endodontic treatment, the dentist removes the dead remnants of the dental pulp and replaces it with an inert filling material which is visible on an X-ray.
Molar teeth (difficult access, low success rate and potential problems with nerves & sinuses)
Patients who have poor oral hygiene, active gum disease or uncontrolled tooth decay
Teeth where the post-crowns do not fit the root canal or the post has been re-cemented on more than 1 occasion
Teeth where there is little tooth substance left to place a crown on afterwards
Teeth which have post-crowns that can be removed to allow re-treatment
Patients who require intravenous sedation / general anaesthesia
Patients at risk from bacterial endocarditis or with blood clotting disorders
There is increased difficulty of the operation due to anatomical & dental anatomical considerations, such as:
Mouth Anatomy. Small oral opening, a prominent chin, Inferior Alveolar & Mental Nerves, active facial & mouth muscles, bony prominences (such as the zygomatic process; anterior nasal spine, external oblique ridge) and a shallow ‘trough’ (vestibule) between the teeth, cheek and lips can hamper the operation.
Jaw Bone Thickness. The jaw bone is thicker in the root tip region and more difficult access to the root end
Upper Premolars / Bicuspids, complicated by:
Multiple Roots are present that often diverge widely from each other (making access for the procedure difficult and hence lower success rate for op)
Sinus Floor can often be in close proximity to the tooth tips that are being operated on. There is a chance of perforating into the sinus (10 – 50% of cases) and causing acute +/- chronic sinusitis (especially if any debris has gone into the sinus).
Root Anatomy. Long and broad roots, that are in proximity to adjacent roots and tilted towards either the roof of the mouth (if upper) or the floor of the mouth (if lower) (making access for the procedure difficult and hence lower success rate for op).