Apicoectomy is a surgical procedure primarily used to treat dental granulomas that cannot be healed through simple devitalization (root canal filling).

The procedure involves two key steps:

1. Removal of the root tip infected with bacteria.
2. Filling the exposed root cavity with a biocompatible material (retrograde root sealing).

• Dental granuloma: Chronic inflammation at the root tip of a tooth.
• Tooth root: The part of the tooth embedded in the alveolar bone, containing the dental pulp (vital part of the tooth).
• Root tip: The point where nerves and blood vessels enter the tooth.
• Root canal: The canal within the root through which nerve fibers and blood vessels pass.

Apicoectomy is performed primarily to permanently seal the root canal at the tip, preventing any possible bacterial access. Although it is a relatively invasive procedure, it is not particularly painful and is always performed under local anesthesia.

1. Diseased or damaged tooth.
2. Drilling and cleaning.
3. Removal of blood vessels and nerves up to the tooth tip using endodontic files.
4. Filling the canal with gutta-percha and covering it with a crown (cap).

If a diseased tooth cannot be devitalized under the following conditions, apicoectomy is the only alternative:

• The infected tooth has already been devitalized and cannot be retreated.
• The root canal is blocked by a fixed post.
• The root canal cannot be accessed with standard surgical instruments.
• The granuloma-affected tooth is already encapsulated.
• The root canal is highly curved and complex.

Only in extreme cases where neither apicoectomy nor devitalization can resolve the infection, tooth extraction remains the last resort.

When is apicoectomy indicated?

In addition to treating granulomas and abscesses, apicoectomy is performed in cases of:

• Root fractures or severe trauma.
• Dental cysts.
• Root perforations.
• Unbearable tooth pain that cannot be treated with endodontic therapy.
• Persistent dental symptoms without visible pathological changes on X-rays.

Which teeth can undergo apicoectomy?

Contrary to popular belief, apicoectomy can be performed on both front teeth and molars. The procedure is quicker and simpler on incisors and canines, as they have a single root canal. On molars, apicoectomy is more complex due to multiple root canals. If the granuloma affects a wisdom tooth, extraction is recommended.

Is apicoectomy painful?

The procedure is performed under local anesthesia, making it virtually painless. However, as it is a surgical procedure, the treated tooth may be more sensitive in the days following the operation, particularly to temperature changes.

Preparing for Apicoectomy

Before undergoing an apicoectomy, a consultation and specialized examination with a trusted dentist are essential. To determine whether apicoectomy is necessary, the dentist must evaluate the tooth’s health and assess the lesion using radiographic imaging.

The dentist must explain the procedure, potential risks, and complications to the patient. It is advisable to inform the dentist of any allergies (e.g., latex, nickel), pre-existing medical conditions, or pregnancy. Patients should also disclose any medications they are taking.

A few days before apicoectomy, patients should follow specific precautions to minimize post-surgical risks.

Standard Pre-Procedure Guidelines:

• Maintain regular oral hygiene by rinsing with disinfectants (e.g., chlorhexidine) 3-4 days before apicoectomy.
• Taking antibiotics one or two days before apicoectomy may help prevent possible infections. Antibiotics are prescribed only by a doctor.
• Taking an anti-inflammatory drug a few hours before apicoectomy may help reduce pain and inflammation after the procedure.

Before undergoing apicoectomy, it is always necessary—and crucial—to ask the dentist any questions, express concerns, and clarify uncertainties.