Treatment
Endodontic microsurgery (apicectomy) in Nottingham
A minor surgical procedure that treats persistent infection at the tip of the root when conventional root canal treatment or retreatment is not possible or has not resolved the problem.
What is an apicectomy?
An apicectomy, or root-end surgery, treats infection that persists around the tip of a root after root canal treatment. Instead of working through the crown of the tooth, the endodontist reaches the root tip through a small opening in the gum, removes the inflamed tissue and the last few millimetres of the root, and seals the end of the canal with a small biocompatible filling.
Performed under the operating microscope with fine instruments and ultrasonic tips, modern endodontic microsurgery is precise and conservative, and its success rates are considerably higher than older surgical techniques.
When is it recommended?
Microsurgery may be the right choice when:
- a tooth has been root treated (and perhaps retreated) but infection remains at the root tip
- a post and crown make retreatment through the crown risky or impossible
- there is a cyst-like lesion around the root that needs to be removed and examined
- a fractured root tip or a blocked canal cannot be treated conventionally
In many cases it allows a tooth with a good crown and filling to be kept without having to dismantle the existing restoration.
The procedure
- The area is numbed with local anaesthetic.
- A small incision is made in the gum and the gum is gently lifted to expose the bone over the root tip.
- The infected tissue and the root tip are removed.
- The end of the root canal is prepared and sealed with a bioceramic filling material.
- The gum is repositioned and closed with a few fine stitches, which are removed after a few days.
The appointment typically takes 60–90 minutes.
Recovery
Some swelling and bruising for a few days is normal and can be reduced with cold compresses and the pain relief we recommend. Most patients return to normal activities the next day. Healing of the bone around the root is checked on radiographs over the following months.
Alternatives
Where microsurgery is unlikely to succeed — for example when a root is cracked along its length — extraction and replacement may be the more predictable option. We will always explain the likely outcomes so you can make an informed decision together with your dentist.