Up until the 1950’s, if the nerve of a tooth became infected due to dental caries, a fracture or trauma, it was necessary to extract the tooth. Over the past half century, tremendous advances have been made in root canal therapy. The goal of root canal therapy is to remove the infected nerve, clean, irrigate and sterilize the remaining canal and fill the canal with an inert material known as gutta- percha. In this way, the canal is sealed preventing further infection and allowing the patient to retain their tooth.
Treatment modalities, methods and materials for root canal therapy have made tremendous advances over the past decades. In fact, today more than 85% of all conventional root canal therapies are successful. Sometimes, however, the infection at the top of the root persists and may even spread locally to the surrounding bone. In these cases there are two options. One is to retreat the existing root canal. The other option, and the more definitive treatment for a root canal that has failed, is to perform a procedure known as an apicoectomy. This procedure is usually performed by either an oral surgeon or a root canal specialist known as an endodontist. The goal of the apicoectomy is to surgically remove the infected material and seal the end of the root.
An incision is made through the gum adjacent to the apex of the affected root. The bone over the root is removed and the infection is exposed. The surgeon will then remove all the infected material and inspect the root tip. The root tip will be removed and the apex of the tooth will be sealed. The entire procedure lasts from half an hour to an hour and a half, depending on the location of the infection.
Patients may expect several days of discomfort and some swelling after this procedure. Antibiotics and anti-inflammatories may be prescribed depending on severity of the procedure and to insure that a secondary infection does not develop.