Why do I need an apicectomy?

Your dentist or surgeon has diagnosed an infection at the root tip of a tooth. This might not cause any symptoms, but patients can present with an infection which shows itself as a swelling or 'gum boil' above the tooth. This might drain infection from the tooth, which you might be able to notice as a bad taste. Infections at the root tip can either be just inflammation, or they can be a cyst which forms when the nerve in a tooth dies ('radicular' cyst).

To give the affected tooth the best chance of being cured, an apicectomy aims to 'clean' the area of infection. A small piece of the root tip is removed at surgery in order to facilitate this 'cleaning'.

What does the procedure involve?

This operation is normally done using local anaesthetic, although some patients choose to have a general anaesthetic (be asleep) or have sedation. A small incision is made to allow your surgeon to see the root tip and cyst or infected area. It may be necessary to have some bone removed with a drill, to reduce the risk of infection the drill is cooled with a stream of saline - a bit like you may have had at the dentist if you've had a filling. The infected area or cyst is cleaned away, and often your surgeon will send a specimen to the pathology lab to ensure that they know just what the cause of your problem has been. It is very rare for the specimen to show anything other than inflammation or a 'radicular' cyst.

A small portion of the root tip is removed using the drill, and a filling is placed at the new root end to seal it off.

Your surgeon will place some stitches (sutures) to put the gums into the correct place, these will usually dissolve in two or three weeks. It's essential that you are careful when brushing to avoid damaging the stitches.

The procedure will take approximately 30 minutes, and if you've had a local anaesthetic you can be sent home once you feel well enough. All patients having general anaesthesia or sedation will have some post operative checks to ensure they are well, and providing you have no medical conditions that require an overnight stay, you'll often be discharged a couple of hours after surgery.

What happens after surgery?

You'll be sent home with some post operative instructions, and details of whom to contact should you have any difficulties or complications. The local anaesthetic will take a couple of hours to wear off, and it is usually sensible to take some simple painkillers before this happens. Recommended painkillers would include paracetamol, ibuprofen or diclofenac - though the actual choice might depend upon your past medical history and any drugs that you take. The surgeon will advise you on the best choice. It is important that, for the first few days at least, you take your painkillers regularly according to the instructions on the pack.

You may get some swelling after surgery, particularly of the upper lip when you have had treatment for an upper incisor tooth. This can be noticeable, so it might not be prudent to have your surgery immediately prior to a big family event! The swelling can last up to a week, but will disappear. If, as part of your job, you speak to the public or have to speak on the telephone you might want to consider taking a couple of days off work.

Keep the surgical site clean is very important, but don't keep pulling your lips away from the site to look at it - this may stretch the stitches. Instead, try using warm salt water mouthrinses after meals to clean the area gently. You may choose to use chlorhexidine mouthwash, but please remember that this can stain your teeth if used too much or for too long. The stain can be removed, but will often need to be done by your dentist.

It is unusual for apicectomy sites to bleed, but if this does happen press gently on the area with one of the swabs you'll be sent home with. If bleeding doesn't stop after 20 minutes, ring for advice.

Infection after apicectomy is unusual, but does happen - don't forget that the reason you had the procedure in the first place was likely to cure an infection. You will be sent home with some antibiotics, please be careful to read the pack/bottle as some antibiotics react very badly with alcohol.

Some patients experience numbness of the gum around the operation site after surgery. This often gets better with time, but may not and is a normal consequence of making an incision to undertake an operation.

Are apicectomies 100% successful?

No, and it is unlikely that any surgeon would tell you they are. A success rate of between 70% and 80% is normal - but sometimes we have to accept that an apicectomy is a tooth's 'last chance', and it doesn't always work.

Are there any other complications?

The site of the incision for your operation can vary, and some incisions have a higher rate of 'gingival recession' than others. This is where your gums appear to shrink back from the crowns of your teeth. Your surgeon will warn you about this if it is a risk, and will take every effort to avoid this complication.

If the surgery fails, sometimes the tooth may need to be extracted - but this will be discussed with you before you undertake to have an apicectomy.

Will the surgeon see me again after surgery?

This depends on your commitments and the complexity of your surgery. Sometimes it is necessary to repeat your x rays after surgery to ensure that healing is occurring. But patients have increasingly busy lives, and it may be more convenient to have any follow up x rays done by their dentist at a routine check up. This will be discussed and agreed by you and your surgeon at or before your surgery.