Having root canal treatment performed on an infected tooth is never a particularly pleasant procedure, but it is the most efficient and reliable way to remove infected tissue from within a tooth, and a successful root canal treatment will usually remain effective for the remaining lifetime of the affected tooth. However, in some rare cases, further treatment involving a procedure known as an apicoectomy may be required.
What is an apicoectomy, and why are they performed?
When a root canal is performed, your dentist creates an opening your tooth and removes the infected pulp and tissue that lies within, all the way down to the tips of the tooth's roots. This procedure is almost always effective at removing bacteria and other infectious agents that have caused your tooth to become infected; however, the root system of even small teeth is extremely complex, and even the most diligent dentist cannot remove all of the infected tissue in a particularly complex tooth during a normal root canal treatment.
If infection remains in one of these small root branches, an apicoectomy may need to be performed. During an apicoectomy, your dentist or dental surgeon will completely remove both the internal tissue and external enamel and dentin that constitutes the infected root branch. The missing branch is then replaced with an inert filler, usually made from metal amalgam, plastic resins or latex compounds; this 'prosthetic' branch prevents the treated tooth from shifting and becoming loosened from the gums after the original branch is removed.
How do you know if you require an apicoectomy?
As you can imagine, it's pretty difficult to tell whether a tiny branch in one of your own teeth is still infected, especially amidst the discomfort usually experienced immediately after a root canal treatment. However, if your recently treated tooth is not healing as quickly as you would expect, or symptoms experienced during the original tooth infection reoccur, this can be a sign that infection remains in the tooth. If you are experiencing slow healing or recurrence of symptoms after having root canal treatment, ask for a repeat appointment with your dentist as quickly as possible.
Your dentist can then inspect the recently treated tooth and the surrounding gums for signs of persistent infection. If your dentist concludes that part of the root system of your tooth remains infected, repeated root canal therapy may be attempted, but if the infected branch is too small and awkward to access via normal means, an apicoectomy may be scheduled. Undergoing an apicoectomy will give you the best possible chance of retaining the affected tooth and avoiding extraction, and the tiny incisions used usually heal quickly and with a minimum amount of pain.