Generally, a root canal is all that is needed to save a tooth with an irreversibly injured pulp (nerve) from extraction. Occasionally, this non-surgical root canal procedure will not be sufficient to heal the tooth due to a persistent and/or recurrent infection. In this type of situation your dentist will evaluate and possibly recommend endodontic surgery or an apicoectomy.
The tip of the tooth root is called the apex; “ectomy” at the end of a word implies removing something. Therefore, an apicoectomy is the surgical removal of the tip of the root of the problem tooth which also removes the infection. A root-end filling is placed to prevent reinfection of the existing root canal and the gum is sutured. After the removal of the root tip and infection the area will heal on it's own.
This surgical procedure is usually preformed by an oral surgeon using local anesthesia . It also has an exploratory nature and can be used to locate root fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this type of surgical procedure.
There are usually no restrictions after the procedure concerning driving or returning to work. If you have requested nitrous oxide (laughing gas) or IV sedation, you will receive special instructions at your consultation appointment about driving and recuperation after the procedure.
Following an apicoectomy, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. Application of ice on the affected side of the face off and on every 20 minutes after surgery for the first 24 hours will help minimize the swelling. To alleviate any discomfort, you will be instructed to take 2-4 ibuprofen (Advil or Motrin). Salt water or antiseptic rinses are also a good idea.