Apicoectomy
An apicoectomy is a surgical procedure that involves the removal of the apical portion of a tooth root along with the surrounding infected periapical tissue, followed by the placement of a retrograde filling to seal the root end. It is performed when non-surgical root canal therapy or retreatment has failed or is not feasible.
An apicoectomy is needed when a root canal-treated tooth continues to show signs of infection or inflammation at the root tip (apex), and retreatment through the crown is not possible or has already failed. It’s a type of endodontic microsurgery that involves removing the apical portion of the root and sealing the end to prevent further infection.
When an Apicoectomy Is Needed
1. Persistent Periapical Infection After Root Canal
- If a root canal has been performed but a periapical radiolucency (indicative of infection or cyst) remains or enlarges.
2. Failed Root Canal Retreatment
- When conventional retreatment has been attempted and symptoms (pain, swelling, sinus tract) persist.
3. Anatomical or Restorative Challenges
- Cases where retreatment is not feasible, such as:
- A post and core that cannot be removed without damaging the tooth.
- Obstructed or curved root canals that prevent full cleaning.
- Complex canal anatomy or instrument separation in the apical third.
4. Apical Cysts or Granulomas
- When chronic apical pathology (e.g., radicular cysts or granulomas) doesn’t resolve after endodontic treatment.
5. Root Fracture or Perforation at Apex
- When the fracture or perforation is confined to the apical part of the root, and the rest of the tooth is healthy and functional.
