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An apicectomy is a surgical procedure in which the
root-tip of a tooth is removed and the truncated root-
tip is hermetically sealed with a root-filling.
An apicectomy (also known as surgical endodontics,
apical surgery or peri-radicular surgery) should be
considered only when conventional endodontic root filling
(‘root canal treatment’) techniques have failed.
A conventional endodontic treatment is indicated if the
dental pulp (‘nerve’) of a tooth becomes non-vital (dies) or
is likely to be put at risk due to the type or size of
restoration needed to repair the tooth.
During endodontic treatment, the dentist removes the dead
remnants of the dental pulp and replaces it with an inert
filling material which is visible on an X-ray.
As there is good evidence that endodontic re-treatment
has higher success rates than apical surgery, patients are
advised to pursue a non-surgical treatment if root canal
treatment is initially unsuccessful (www.aae.
org/patients/patientinfo/faqs/retxsum.htm and www.
britishendodonticsociety.org.uk/patient_information.html).
Most teeth will respond satisfactorily to this type of
treatment and become symptom-free.
root-tip of a tooth is removed and the truncated root-
tip is hermetically sealed with a root-filling.
An apicectomy (also known as surgical endodontics,
apical surgery or peri-radicular surgery) should be
considered only when conventional endodontic root filling
(‘root canal treatment’) techniques have failed.
A conventional endodontic treatment is indicated if the
dental pulp (‘nerve’) of a tooth becomes non-vital (dies) or
is likely to be put at risk due to the type or size of
restoration needed to repair the tooth.
During endodontic treatment, the dentist removes the dead
remnants of the dental pulp and replaces it with an inert
filling material which is visible on an X-ray.
As there is good evidence that endodontic re-treatment
has higher success rates than apical surgery, patients are
advised to pursue a non-surgical treatment if root canal
treatment is initially unsuccessful (www.aae.
org/patients/patientinfo/faqs/retxsum.htm and www.
britishendodonticsociety.org.uk/patient_information.html).
Most teeth will respond satisfactorily to this type of
treatment and become symptom-free.
| Apicectomy / Surgical Endodontics – What Is It? |
The 2 main indications for apical surgery are:
There is increased difficulty of the operation due to
anatomical & dental anatomical considerations, such as:
Upper Premolars / Bicuspids, complicated by:
Lower Incisors & Canines / Eye-Teeth (Upper & Lower),
complicated by:
Useful websites:
www.britishendodonticsociety.org.uk/patient_information.
html
www.aae.org/patients/patientinfo/faqs/endosurgery.htm
www.britishendodonticsociety.org.uk/profession/quality-
guidelines.pdf
www.rcseng.ac.
uk/fds/clinical_guidelines/documents/surg_end_guideline.pdf
- Obtain a biopsy (where the tooth-tip pathology is
greater than 1cm in diameter) - To achieve what could not be done by endodontic re-
treatment such as:
- The recovery of broken / retained of root-canal /
endodontic instruments - Where the root canal is in-filled / blocked / obliterated
- The repair of root perforations
- Where the root is fractured
- Where there is good root canal treatment yet still root
pathology
-
where the bridge support is in a reasonable condition (ie the bridge / tooth can readily be ‘saved’)
Apicectomies ARE NOT done on:
- Teeth that have been previously apicected (low
success rate for repeat apicectomies) - Molar teeth (difficult access, low success rate and
potential problems with nerves & sinuses) - Patients who have poor oral hygiene, active gum
disease or uncontrolled tooth decay - Teeth where the post-crowns do not fit the root canal
or the post has been re-cemented on more than 1
occasion - Teeth where there is little tooth substance left to place
a crown on afterwards - Teeth which have post-crowns that can be removed to
allow re-treatment - Patients who require intravenous sedation / general
anaesthesia - Patients at risk from bacterial endocarditis or with
blood clotting disorders
There is increased difficulty of the operation due to
anatomical & dental anatomical considerations, such as:
- Mouth Anatomy. Small oral opening, a prominent chin,
Inferior Alveolar & Mental Nerves, active facial &
mouth muscles, bony prominences (such as the
zygomatic process; anterior nasal spine, external
oblique ridge) and a shallow ‘trough’ (vestibule)
between the teeth, cheek and lips can hamper the
operation. - Jaw Bone Thickness. The jaw bone is thicker in the
root tip region and more difficult access to the root end
Upper Premolars / Bicuspids, complicated by:
- Multiple Roots are present that often diverge widely
from each other (making access for the procedure
difficult and hence lower success rate for op) - Sinus Floor can often be in close proximity to the tooth
tips that are being operated on. There is a chance of
perforating into the sinus (10 – 50% of cases) and
causing acute +/- chronic sinusitis (especially if any
debris has gone into the sinus). - Root Anatomy is such that they are often difficult to
get a good root canal filling (due to isthmus /
anastomosis of the root systems). Hence, the
chances of success of the apicectomy will be reduced.
Lower Incisors & Canines / Eye-Teeth (Upper & Lower),
complicated by:
- Root Anatomy. Long and broad roots, that are in
proximity to adjacent roots and tilted towards either
the roof of the mouth (if upper) or the floor of the
mouth (if lower) (making access for the procedure
difficult and hence lower success rate for op).
Useful websites:
www.britishendodonticsociety.org.uk/patient_information.
html
www.aae.org/patients/patientinfo/faqs/endosurgery.htm
www.britishendodonticsociety.org.uk/profession/quality-
guidelines.pdf
www.rcseng.ac.
uk/fds/clinical_guidelines/documents/surg_end_guideline.pdf
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