Apicoectomy

An apicoectomy (also called apical surgery or root-end resection) is a surgical procedure to remove infected tissue at the tip of a tooth root, remove a few millimeters of the root tip, and seal the root end with a special filling material (MTA or bioceramic). It is performed in the clinic under local anesthesia. Apicoectomy is the last surgical option to save a tooth when root-tip infection cannot be resolved with root canal treatment or retreatment. When infection cannot be reached from inside the tooth (orthograde approach), it is surgically cleaned from the gum side (retrograde approach). During surgery, the cyst or granuloma tissue removed from the root tip is sent to a pathology laboratory for examination. This examination is important to confirm the structure of the lesion.

Root canal retreatment is performed from inside the tooth: the old canal filling is removed, the canals are cleaned again, and refilled. It does not involve surgical intervention. Apicoectomy, on the other hand, involves surgical access to the root tip from outside the tooth, through the gum: the root tip is cut, infected tissue is cleaned, and a retrograde filling is placed at the root end. The choice between the two is based on these criteria: if retreatment from inside the canal is possible (canals are accessible, posts or broken files can be removed), retreatment is preferred. If access from inside the canal is not possible (blocked canals, posts that cannot be removed, calcification) or if retreatment has been tried before and failed, apicoectomy is considered. Apicoectomy also has advantages in cases where valuable prosthetic restorations need to be preserved. At Doredent, this decision is evaluated individually for each case, and the most appropriate approach for the patient is honestly recommended.

Because an apicoectomy is performed under local anesthesia, you will not feel pain during the procedure. Moderate pain may occur for a few days after surgery. This pain may be more noticeable than sensitivity after standard root canal treatment because surgical intervention was performed on bone and soft tissue. Pain is controlled with pain relievers and anti-inflammatory medications prescribed by your dentist. Pain typically decreases significantly within 3-5 days. Most patients return to normal comfort within one week. Swelling and bruising may occur in the surgical area. These are temporary and largely subside within a week. Patients often say that their expectations before surgery were worse than what they actually experienced. Applying cold compresses, eating soft foods, and following your dentist's recommendations significantly ease the healing process.

An apicoectomy is usually completed in 30-60 minutes. The duration varies depending on the location of the tooth, the size of the lesion at the root tip, the proximity of anatomical structures, and the complexity of the case. Front teeth have easier surgical access, so the procedure is usually shorter. Back teeth may have more difficult surgical access, and the duration may be longer. Teeth with multiple roots may require separate intervention for each root. The procedure is completed in one session. There is no need for a second session. A short follow-up appointment is scheduled approximately 10 days later to remove stitches.

The healing process is evaluated in two stages: soft tissue and bone healing. Soft tissue (gum) healing is usually largely complete within 2-3 weeks. Swelling peaks on days 2-3 and subsides within a week. Bruising disappears within a week. Stitches are removed on day 10. Most patients can largely return to normal daily life after 1 week. Bone healing, however, is much slower. Bone filling the defect at the root tip and the lesion site can take 3-6 months. During this process, healing is monitored with follow-up X-rays at 3, 6, and 12 months. Shrinkage of the lesion indicates that treatment is progressing successfully.

Success rates with modern apicoectomy techniques are generally high. Success rates have increased significantly with retrograde fillings made with MTA or bioceramic materials, retrograde cavities prepared with ultrasonic tips, and microsurgical principles. Factors affecting success rate include: the size of the lesion (success is higher with smaller lesions), tooth location (front teeth have easier access, higher success), quality of previous treatments, whether there are cracks in the root structure, and the patient's general health condition. If apicoectomy fails, the final option is tooth extraction and implant treatment. At Doredent, the chance of success is honestly evaluated before surgery. In cases with very poor prognosis, unnecessary surgery is not performed.

Stitches are placed to close the gum incision during surgery. These stitches are usually removed after 10 days. Stitch removal is a very simple procedure that takes a few minutes, is usually painless, and does not require anesthesia. Until stitches are removed, the surgical area is not brushed. However, oral hygiene is supported with the antiseptic rinse (chlorhexidine) recommended by your dentist. Teeth outside the surgical area continue to be gently brushed. During stitch removal, the healing status of the surgical area is checked. If any problems are detected, necessary intervention is planned at this session.

Yes. The cyst or granuloma tissue removed from the root tip during apicoectomy is sent to a pathology laboratory for histopathological examination. This examination is important to confirm the structure of the lesion. The purpose of pathology examination is to confirm whether the lesion is truly infection-related (granuloma, cyst). In very rare cases, the lesion at the root tip may be a different pathological formation instead of the expected infectious structure. Pathology examination detects these rare situations, and if necessary, additional treatment is planned. Pathology results usually reach the clinic within 1-2 weeks. Results are communicated to the patient, and if necessary, the treatment plan is updated.

Apicoectomy is the last surgical opportunity to save a tooth in the treatment hierarchy, just before extraction. Treatment steps follow this sequence: first root canal treatment, if unsuccessful retreatment, if retreatment is not possible or unsuccessful apicoectomy, if apicoectomy is unsuccessful extraction and implant. However, this hierarchy does not always have to be applied in order. In some cases, apicoectomy may be planned directly because retreatment is not technically possible. In some cases, the prognosis of the tooth is so poor that extraction may be a more correct decision than attempting apicoectomy. At Doredent, this evaluation is made individually for each case. If the tooth has a chance of being saved, extraction is not recommended until all options are exhausted. However, if the prognosis is poor, it is also not right to put the patient through unnecessary treatment processes. This balance is honestly established at the initial examination.