Periapcial Surgery

Patients may be referred by their dentist for the oral surgeon to evaluate a tooth for an apicoectomy (“apico” or periapical surgery). This is a procedure that may be indicated as an attempt to repair, salvage or fix a tooth that has inflammation or abscess around the root. In most cases, this is performed on a tooth that has previously had root canal treatment that has not completely restored health. Root canal treatment involves cleaning the inside of the tooth and filling the space within the root or roots in order to cure or prevent abscess formation. While this sounds like a simple thing, the internal anatomy of teeth can be complex and with the best efforts, sometimes the goals are not or cannot be achieved. The reasons to consider this surgery is for teeth that have had root canals but continue to have pain, inflammation or infection. Sometimes there is no pain but there is a small bump, “pimple” or fistula in the gums adjacent to the tooth. While this does not allow the pressure to build up and create pain, it is a sign that something is not healthy.

Periapical surgery is a way to directly approach the problem area, usually at the tip of a root, with surgery. The goals are to clean out the affected area which may or may not be infected. This usually involves removing a small part of the root tip, which also allows the surgeon to examine the root canal filling. Often the area has not healed because of an incomplete seal in the root which may result from difficulty placing the filling material from the other end of the tooth or from extra canals that were not treated with the original root canal. This does not mean that the previous treatment was faulty. Often it occurs because of anatomical abnormalities from extra canals or canals that have divided into two somewhere within the root.