Teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip or end of each root is called the apex. Nerves and blood vessels enter the tooth through the apex. They travel through a canal inside the root, and into the pulp chamber. This chamber is inside the crown (the part of the tooth you can see in your mouth).
Root canals can be very complex, with many tiny branches off the main canal. Sometimes, even after root canal treatment, infected tissue can remain in these branches. This can possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.
The endodontist will make a small incision (cut) in your gum and lift the gum away from the tooth and bone. The dentist may need to use a drill to gain access to the root. The infected tissue will be removed along with the last few millimeters of the root tip. The endodontist may use a dye to highlight cracks and breaks in the tooth. If the tooth has large cracks or breaks, it may need to be extracted. In this case, the apicoectomy will not continue. To complete the apicoectomy, the endodontist will clean and seal the end of the tooth’s canal. The cleaning usually is done under a special microscope using ultrasonic instruments. The light and magnification allow the endodontist to see the area clearly. This increases the chance that the procedure will succeed. The endodontist then will take an X-ray of the area before stitching the tissue back in place.
Most apicoectomies take 30 to 90 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.
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