Endodontics – when a root canal is not effective!
The most common form of endodontics dental procedure, that occurs below the teeth, is the root canal in Edinburgh. These are often performed as part of referrals from other clinics, this means we tend to see the most complex and advanced cases. Sometimes more than root treating is needed to resolve the underlining infection, this is when we would perform an apicoectomy!
Apicoectomy
This is an overly elaborate name for the removal of the root tip and sealing the tooths canal from under the tooth. The complexity of an apicoectomy makes it a secondary treatment option that is performed after a failed root canal. The response for a failed root canal in Edinburgh varies from case to case but the common causes, are impacted or very tightly angled roots that cannot be internally cleaned with files, fractures from top down to the tip of the root re-introducing infection and branched roots that are to narrow to clean and fill.
How is an apicoectomy performed?
An apicoectomy is guided by a set of x-rays which are performed usually a week or so before the procedure along with a course of antibiotics to reduce and control the active dental infection. This allows our practising dentist to prepare a treatment plan before the work starts.
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Step 1: A local numbing agent will be applied followed by the injection of local anaesthetic, this will be tested to ensure the area is fully numbed before proceeding.
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Step 2: An incision is made in the gum in front of the affected tooth and held open exposing the root of the tooth down to the jaw bone.
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Step 3: The infected tissues are removed, this will include some soft tissue going down to the meeting point of the jaw bond and the root as well as the root tip and a small part of the jaw bone.
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Step 4: The root canal is cleaned and filled from beneath the tooth, this is usually only a few mm and not the whole tooth.
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Step 5: An inert filler is used to replace any tissues that were surgically removed, this filler will dissolve and be reabsorbed by the body has the area heals.
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Step 6: The gum tissue is closed up and sutured into place.
Depending on the location of the tooth and the number of roots involved the procedure can take between 90 – 130mins. Follow up x-rays are used to confirm all the infected tissues were removed, the jaw bone is healing correctly and the tooth is stable.
Apicoectomy recovery
Despite the surgical nature of the work, an apicoectomy only causes minor discomfort with some localised swelling, the sutures in the gum are removed in a few days and total recovery should be expected in 14 days, not much longer than a Root Canal in Edinburgh! If any symptoms persist after 14 days and are worrying contact the surgery for a check-up.
If an apicoectomy is performed it is usually the last attempt to recover a tooth and the only remaining option would be an extraction.