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Apicectomy

The Problem

An infection has occurred at the tip of the root or roots of a tooth, spreading into the surrounding bone that supports the tooth. Occasionally people may be unaware of the problem but usually there is discomfort, episodes of swelling, gumboils or bad taste.

Why do I need Treatment?

If left untreated the infection will spread possibly developing into an abscess or cyst, or damaging bone around adjacent teeth. The tooth may become loose. The infection cannot be cured with antibiotics, but they are often used to give temporary relief of symptoms.

What is the Treatment?

An apicectomy is a small surgical procedure designed to cure an infection at the tip of the root or roots of a tooth. It is indicated when, for a variety of reasons, it has proved impossible for your dentist to cure the infection by removing the dead nerve and placing a root filling. It is most frequently carried out under local anaesthetic (injection into the gum). A small cut is made in the gum, which is then lifted off the bone. Access through the bone to the root tip is made using a drill. The infection is cleaned out, part of the root tip removed and a small filling placed in the end of the root. The gum is replaced with dissolvable stitches.

What can I expect after the operation?

As the local anaesthetic wears off a few hours after surgery there may be some discomfort but this is quite variable. This is usually managed with a single dose of an analgesic such as Ibuprofen. Antibiotics may also be prescribed. Analgesics are seldom required after the first day. Some swelling at the operation site and sometimes overlying skin is normal. This is worse 24-48 Hours after the operation and resolves over the next few days. It is important to keep the site of surgery as clean as possible. The area can be brushed gently with a toothbrush softened in hot water, together with hot salty mouthwash (teaspoon of salt in a beaker of warm water), 2-3 times a day, beginning the day after surgery and continuing for 1 week.

What are the possible problems?

Prolonged bleeding is rare but if it occurs pressure with a cotton handkerchief or swab for at least 10 minutes usually stops it. Some tooth roots lie very close to important nerves which if damaged may cause numbness of the lower lip and chin on one side. If this risk is present your surgeon will discuss it with you. Occasionally the gum will shrink back slightly following surgery, which may expose the margin of a crown if one is present. The operation is occasionally unsuccessful at removing the infection. If unsuccessful after 2 attempts the tooth is probably better removed.