The word apicoectomy refers to a procedure involving surgery to the area around the end of the root of a tooth.   Another name for the procedure is periapical surgery.  This procedure is usually perfomed on a tooth that has already had root canal therapy.  A root canal procedure can fail when it is not possible to adequately clean or seal the root of a tooth.  Multi-rooted teeth like the maxillary or mandibular molars are more prone to this problem.  The internal anatomy of the roots is such that there are often accessory canals or areas the dentist or endodontist cannot negotiate during the root canal procedure.  There are also some rare cases where the root canal is calcified and it is impossible to perform root canal therapy in the first place.  The body's immune system reacts to the dead tissue that remains in the root canal system.  This causes discomfort and loss of bone at the end of the root.  If this process is allowed to progress, the bone loss can become so severe as to result in loss of the tooth.   

The signs this type of problem is occurring are swelling in the gums or the cheek adjacent to the tooth, drainage from the side of the gums and/or discomfort when chewing or putting pressure on the tooth.  It is common to have a course of antibiotics prescribed when these symptoms initially develop.  However, this will not actually treat the problem long term.  The diseased tissue/bone at the end of the root and root tip need to removed and the remaining root sealed to effect a proper cure.

The apicoectomy procedure is performed in the office.  We generally provide sedation and/or general anesthesia for your comfort.  The procedure varies in length but usually takes approximately one hour.  In most cases a single root is causing the problem.  However, multi-rooted teeth will sometimes need two or even three roots treated.  In cases involving a past history of trauma to the region, several teeth might require surgery.  If the bone loss in the area is severe, bone grafting might also be performed.

There are instances when an apicoectomy is initiated and, upon exploration othe area, it is determined that a crack is present in the root.  In this situation extraction of the tooth would be indicated.  An apicoectomy performed on a tooth with a cracked root will generally always result in failure.  It is better to identify this early in the treatment process and remove the tooth to prevent further bone loss and infection.