Apicectomy and Surgical Endodontic Treatments

Apicectomy Price indication
Anterior tooth $1100
Posterior Molar $1350

What Is A Root Canal?

Note: Wayne does not do root canal therapy – this is performed by your dentist or specialist endodontist. Wayne does surgical treatments on the tooth root.  I’ve started back to front with the success of the treatment first then an overview follows. Most people  want to know if apicectomy is going to work for them before they read all the fine print.

Apicectomy Success

If the cause of the failed root filling is a problem located around the root tip or apex then removal of this apex will result in a cure of the problem (this is what an apicectomy does). Approximately 65% of failed root canal treatments fall into this category. The other 35% are usually a type of tooth fracture / split. These split teeth are not normally curable. If it affects only one root of a two or three rooted tooth then the affected root can be removed (root amputation) but this does weaken the remaining tooth and it’s longevity can be compromised. Often a split root can’t be diagnosed until the surgery has begun and the gum pushed back to examine the root under magnification. Therefore a degree of uncertainty surrounds apical surgery; if there is an obvious apical problem with a clear cause such as a poor root filling at the apex then apical surgery is highly likely to be successful. If there is a satisfactory appearing root filling but the tooth has a long post, a history of injury and gum pocketing around the tooth then there is a high chance it’s fractured. Failed apicectomies usually become apparent within 3 months of surgery. The failure isn’t usually painful but there is a return of a small sinus or pimple on the gum and the tooth may become uncomfortable to bite on. 95% of failed apicectomies will occur within the first year of treatment, therefore after 12 months and with confirmation on X-ray of boney healing you can be confident to crown the tooth if required. Wayne will examine your mouth carefully, take a 3D CT scan of the tooth, and give his opinion on your best options for treatment. Because of the wide number of factors, costs and long term considerations a thorough examination and discussion on options is essential before deciding on treatment. It maybe that starting anew with a reliable implant is a better option than persevering with an unpredictable tooth, each case is individual and requires careful consideration.

Not all apicectomies are the same and it is important to know what type of procedure your surgeon will use. The picture below shows 3 main types of procedures. The traditional apicectomy with a dental drill, then one with a drill and greater than 3x magnification and finally with Piezo ultrasonic surgery. You will see the long term success rates increase significantly.

Piezo Surgery success

Wayne uses a Mectron Piezo surgery unit with diamond tips, 3.5x magnification, MTA (Mineral Trioxide Aggregate) for the retrograde filling and CT imaging of the tooth prior to determine if fractures or additional canals are present. As a specialist I offer every available tool to maximise success and I perform this routinely. All recent published scientific literature supports this approach (which is at the bottom of this page for the geeks out there).  If you are going to have surgery do it once and use the best modern microsurgical techniques.

About Root canals and root fillings

A root canal is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.

At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.

If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment.You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.

 tooth after endodontic treatment
 

Apicectomy – An Overview of Endodontic Surgery

Why Would I Need Endodontic Surgery?

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and your endodontist or dentist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicectomy or root-end resection.

What Is An Apicectomy?

The video on the right illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.

Types of Cracks

Craze lines

These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.

Fractured Cusp

When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely damages the pulp, so root canal is not necessary. Your dentist will usually restore the tooth with a full crown.

Treatable Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.

Split Tooth

A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.

Vertical Root Fracture

A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise, the tooth will have to be extracted.

Current literature on Apicectomy outcomes

Wayne uses magnification, ultrasonic root end prep and MTA fillings

Apicectomy outcomes