Teeth are attached to jawbones through roots. The apex is the tip of a root. The blood vessels and nerves enter a tooth through the apex. They traverse through the root canal that runs up through the tooth into the pulp chamber. The pulp chamber is inside the crown of the tooth.
After a patient has had a root canal treatment to remove infection and he has a relapse of the infection, an apicoectomy will be needed to treat this reinfection. The root canal treatment conducted earlier may have cleaned the root canal of the infection-affected inflamed tissue.
However, root canals are complex structures that have many branches that run off the main canal. It may just be possible that infected debris may still be left over in a branch of the root canal and be the cause of the reinfection.
In an apicoectomy, the apex or root tip is also removed besides the infected tissue and a filling is used to seal the end of the root.
An apicoectomy is also referred to by the name endodontic microsurgery, because a surgical microscope is used in conducting it.
Usually such a reinfection occurs due to an issue related to the root apex. Another aspect is that an apicoectomy is performed only after a root canal procedure involving the infected tooth root has already been conducted at least once. Further, the dentist conducts an apicoectomy to save the tooth from being extracted because of reinfection.
In some cases, another root canal treatment is first envisaged to be done before an apicoectomy. The second root canal treatment may help remove the infection through use of advances in technology that can detect infection in additional canals. This may help avoid the apicoectomy entirely.
A root resection is different from an apicoectomy. The difference between the two procedures is that in an apicoectomy only the root tip or apex is removed, whereas in a root resection the entire root is removed from an infected tooth.
Preparation for an apicoectomy entails a consultation with a dentist, who will after the requisite checkup, x-ray examination, and an antimicrobial mouth rinse refer the patient to an endodontist. An endodontist is a specialist in endodontic microsurgery.
An apicoectomy cannot be conducted in case a patient has high blood pressure.
The actual apicoectomy may last 30 to 90 minutes. In it an endodontist will cut and lift the gum tissue to reach the root. Thereafter he will first use a dye to highlight the fractures and cracks.
If cracks or fractures are visible in the tooth, the apicoectomy will be canceled and the tooth will have to be extracted.
If no such cracks or fractures are visible, he will then remove the infected tissue alongwith the last few millimeters of the apex. To complete the procedure, the endodontist will clean and seal 3 to 4 millimeters of the root canal end through use of a surgical microscope.