An Apicoectomy is a dental surgery utilized when root canal treatment fails, and there is an infection in the root of the tooth.  The access for this procedure is from the root end of the tooth instead of from the crown end.  While this surgery is only performed when conventional root canal retreatment is not practical, an apicoectomy can save the tooth, bone and gum tissues, returning them to health for a good many years.  The only alternative and a last resort is to extract the tooth.

In order to understand this surgery, it helps to know the tooth structure.  The root canal system is the natural cavity within the center of the tooth that contains the dental pulp, extending from the crown of the tooth to the end of the root.  Teeth always have at least one root, and each root always has at least one root canal.  The tip or end of each root is called the apex, where nerves and blood vessels enter the tooth.   Sometimes there can be many tiny branches off the main canal, and that can make root canal treatment very complex.  Even after root canal treatment, healing can be prevented and re-infection occur, because infected tissue can remain in these branches.  Disinfecting the root canal system is the primary goal of any endodontic treatment.

An apicoectomy surgery uses an approach through the gum tissues at the same level as the affected root, to allow removal of any inflamed or infected tissue near or around the tip of the root, and including a few millimeters of the root’s tip.  A very small filling is then placed in the end of the root canal to seal it and prevent further infection.  The incision in the gum is then closed with a few stitches.  When there’s bone loss, a bone graft can be placed.  With the infection gone, the bone and tooth root will heal.  If left untreated, infected roots can spread infection, damage other teeth, and cause bone loss and loose teeth.

These are some of the reasons why an apicoectomy may be necessary:

  • Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation and infection can persist.
  • Blocked Root Canal – Not possible to effectively clean a root canal due to blockage from calcification or by a fractured file left behind from prior root canal treatment.
  • Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.

Cutting-edge technology, such as fiber optic lights, operating microscopes, and ultrasonic instruments that clean with high frequency vibration, is now in use when performing endodontic surgery, allowing for a very accurate view of the tooth’s interior, and making the treatment quick, comfortable and successful.  Really, it’s not as scary as it sounds, and you will be free of pain and feeling as good as new in no time at all.

If you are interested in apicoectomy in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.