However, in some 2% of all such cases of infection of the roots of a tooth, some bacteria cannot be removed from the very tips of the root via conventional Root Canal Treatment alone, and in these exceedingly rare situations an Apicectomy may be required.
An Apicectomy is a minor, pain-free, surgical procedure carried out by an oral surgeon or endodontist to remove the resistant infection – usually caused by bacteria becoming ingrained in the outside of the root tip or in the surrounding bone itself. Your specialist provider will surgically remove the tip of the root which is compromised by the embedded infection after which, just as in a routine Root Canal Treatment, your root canal system will be thoroughly disinfected and resealed to prevent reinfection by bacteria.
Often, a tooth that has undergone previous Root Canal Treatment will last you for the rest of your life when properly maintained and cared for. However in such rare cases where the root system doesn’t correctly heal, or the tooth becomes painful or reinfected months or even years after successful treatment, Apicectomy surgery may help save your natural tooth and allow you to avoid needing to have it extracted and replaced.
Damage to the root tip by recurrent infections to the area or else damage caused by operator error during an initial Root Canal Treatment are also reasons that might necessitate an Apicectomy. At Dame Street Dental Clinic your specialist dentist will always carry out a full assessment of your mouth to determine what solution is right for your unique case. A failed Root Canal Treatment may not present with any noticeable pain to the patient for many years, or with only an unusual boil or pimple along the gum. Another reason why it is so important to keep to the dentist-recommended twice yearly check-up exams following any Root Canal Treatment, as they can then monitor your tooth for any changes or complications – including making a diagnosis of a failed Root Canal Treatment, which usually requires X-Ray evidence to confirm.Book online
Whether you book an appointment because of new pain, toothache or discomfort, recurrent infections, or a persistent issue with a previously root canal-treated tooth, if on examination your dentist’s assessment indicates that an Apicectomy might be called for, you will be scheduled for an initial consultation at the clinic with either our specialist endodontist (root canal dentist) or an oral surgeon.
Your specialist provider will carry out a comprehensive examination of your tooth, the root canal system, and surrounding bone mass - including taking an additional CBCT 3D dental scan if necessary - to create as full and accurate a picture as possible of your case and the anatomy of the problem. They will make an expert assessment of your root system and the infection or damage at that time, and will recommend the best course of action for your situation, whether that is a conventional Root Canal Treatment or a surgical Apicectomy.
At this point any concerns or questions you may have regarding this micro-surgical procedure will be addressed, and the specialist will be able to provide you with a full treatment plan and full breakdown of the duration of each stage, including any restoration of your tooth following the procedure, and the total costs involved. You will then be scheduled in for your return visit to have the procedure carried out only once you are fully happy with the proposed plan and ready to proceed.
Using a highly effective local anaesthetic, the surgical area will be completely numbed prior to beginning the surgical procedure to ensure that this visit is completely pain-free. For nervous patients we do also offer to carry out this procedure under dental sedation, allowing you to benefit from dental care procedures without fear or anxiety. If this is an option you would prefer to avail of you can discuss this with the specialist during your initial consultation.
A minor incision will be made to allow a flap of the gum to be lifted, exposing the bone and infected root tip. A small amount of the surrounding inflamed tissue and bone are then surgically removed along with the root tip to completely eliminate all damage and persistent, embedded infection, following which the entire area is fully sterilised and disinfected.
Your initial Root Canal Treatment of that tooth will then be reassessed, and any additional cleaning and removal of decayed or damaged pulp or tissue from the root interior that is required will be done at this stage. Your root tip will then be filled and sealed to prevent reinfection of the root. Finally, your gum will be sutured back in place using some dissolvable stitches.
Your entire procedure will take between 30 and 90 minutes to complete, depending on the exact situation of your tooth. Following your treatment the specialist will provide you with detailed post-operative instructions and aftercare guidance, to ensure you are informed of how to best manage the surgical site to avoid any complications or issues. It is quite normal to experience some swelling or tenderness at any surgical incision site, so you will be provided with a prescription for appropriate pain medication for your case as needed – although some patients find that they can well manage any discomfort with only over-the-counter pain relief.
Due to advances in the field of Root Canal Treatments and game-changing new technology (such as our Dame Street Dental’s highly accurate dental microscope), even complex or embedded infections of a tooth’s root system can be treated non-surgically, and Apicectomy procedures are therefore increasingly rare. There are, however, still some cases where our specialist clinical team will recommend an apicectomy procedure:
Your initial Root Canal Treatment has been completed to the highest standards, but the bone or tissue surrounding the exterior of your tooth’s root tip is still showing signs of persistent, ingrained infection
Avoiding damage or the need to replace a patient’s permanent restoration (such as a dental Crown) which is preventing traditional access through the tooth to the root canal system, without damaging the Crown.
In the event of Root Canal Retreatment being advised due to failure of an initial root canal treatment, the extent of re-infection or severe decay or damage to the root tip can make an apicectomy the only option to save a tooth that will otherwise need extraction
The only alternative to a specialist-performed apicectomy is to have your tooth extracted. At Dame Street Dental we will always do our utmost to save your natural teeth whenever possible, while still working in partnership with you to make the best recommendations for your situation to safeguard your dental health and taking into account your individual treatment goals, needs, and priorities.
During your initial consultation with your dentist, we will always provide you with all the information you need to make an informed decision about any available options and their projected outcomes for your specific case. If you decide to opt for tooth extraction over an apicectomy, there are a number of highly effective and aesthetic treatment options to discuss in that case to replace the missing space, such as Dental Implants, Bridges, and Dentures.
It is normal following any surgical procedure to experience some discomfort or slight swelling at the site of the incision. As an apicectomy is a micro-surgical procedure and so a little more invasive than a standard Root Canal Treatment, it is common to experience some mild pain, discomfort, and swelling in the aftermath of your appointment, which should begin to fade after about 2 days. Your dentist will have prescribed you an appropriate pain relief medication at your appointment to manage this discomfort, in addition to providing other aftercare guidance and instruction.
The incision itself will heal in a matter of 1 to 2 weeks, and your bone will heal around the filling that has been placed at your root-tip, naturally restoring full biting strength and function over a period of 2 to 3 months.
No, before your surgical procedure begins you will be administered a highly effective local anaesthetic to ensure the entire appointment is completely pain-free – all that you will feel throughout is some gentle pressure and some vibration.
For anxious or fearful patients, we also offer the option to undertake this or any treatment under Dental Sedation. This allows even the most nervous patient to remain completely relaxed and at ease throughout this micro-surgery, allowing you to remain conscious but in a drowsy, dream-like state and with no unpleasant memories of your treatment afterwards.
An apicectomy will have no long-term impact on your diet or eating habits. However it is strongly advised that you eat a soft diet for at least 4 days after this procedure treatment; for example, soups, yoghurt, porridge and similar.
This allows for undisturbed healing of the surgical site, and will limit any pain or tenderness you experience. You should also chew on the other side of your mouth to the surgical site to avoid biting down on your treated tooth during this period.
An apicectomy (or ‘apical surgery’) is a very safe procedure. As it is a dental microsurgery, it can be undertaken utilising only local anaesthetic, avoiding all of the potential risks of any procedure requiring full anaesthesia.
During the apicectomy procedure, your specialist endodontic dentist or oral surgeon will have complete direct vision of the root of your tooth. The chief risk of an apicectomy is that your dentist may in some cases discover the presence of a crack or fracture in your tooth, further up the root structure under the gumline, that was not apparent before beginning the procedure. If this crack is severe then the apicectomy will not be continued, as the tooth will instead need to be extracted. This is less a risk of the procedure itself, but rather an unknown factor that patients should be prepared for in advance – as there is no benefit to continuing with a costly, invasive procedure where success has been compromised and severely limited by a deep fracture in the tooth. In this instance, proceeding with the apicectomy would only postpone the need for an eventual extraction in the short-term.
The possibility of this eventuality will be discussed with you by your clinician before the procedure, and a contingency plan put in place for how you would like to proceed in that turn of events, including a full and detailed discussion of your options and preferences for restoring the missing tooth with a replacement afterwards.
An apicectomy carried out by an experienced specialist utilising state-of-the-art materials, equipment, and technique is considered to have a success rate of 90%.
To ensure the long-term success of your tooth it is important to maintain regular twice yearly check-up visits with your dentist and hygienist, as well as implement an effective oral hygiene routine involving brushing twice per day and flossing daily. When properly monitored and taken care of in this way, a root canal or apicectomy-treated tooth can last just as long as any other natural teeth.
At Dame Street Dental, an apicectomy procedure costs €900. This price reflects the specialist nature of this micro-surgical treatment and the expert experience of our endodontist and oral surgery team.
Your dentist will be able to discuss the cost for your individual case and a detailed breakdown of your treatment plan and costs. At Dame Street Dental we are delighted to offer multiple payment plans to suit all treatment needs, lifestyles, and budgets. One of our available plans allows you to pay for your treatment monthly, with absolutely no down payment required and at 0% interest!
Suffering from recurrent pain, sensitivity or new symptoms at the site of a previous Root Canal Treatment?