Apicectomy

This procedure is done if an infection or a cyst has occurred at the tip of the root of your teeth. This usually presents as discomfort and occasional episodes of swelling, gum boils or bad taste. You may well already have been given a course of antibiotics in an attempt to treat the infection. Sometimes there may not be any symptoms and picked up on routine xrays.

Reason for treatment?
The dentist will have already tried to get rid of the infection by removing the nerve of the tooth and placing a root filling. Sometimes this may not clear the infection. If left untreated the infection is likely to develop into an abscess or cyst. As well as causing pain this can lead to the loss of bone surrounding the root. As a result the tooth will become loose.

What does the procedure involve?
The infection in the bone needs to be removed surgically in a procedure called an “apicectomy”. This involves cleaning out the infection from the bone, removing a small portion of the tip of the root of the tooth and then sealing the root with a small filling.
It is necessary to make a cut in the gum over the root of the tooth. The area of infection is uncovered by removing a small amount of bone with a drill. Infected tissue is thoroughly cleaned away from the tip of the root. About 2-3mm of the root tip is removed. The root canal is sealed with a filling. The gum is then stitched back into place with dissolvable stitches.

Type of anaesthetic?
It depends on difficulty and patients choice

Local anaesthetic – this is an injection in the mouth, similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you will feel no pain while the wisdom tooth is removed. This is the best option for wisdom teeth that are simple to remove.
Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection into your arm. This makes you feel relaxed and less aware of the procedure.
General anaesthetic –This means you are put to sleep during the procedure. It is usually possible to be done as a “day case” procedure, ie you will be able to go home on the same day as surgery.
What are the complications?
Bleeding:It is unusual for the area to bleed after surgery but should this happen it can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled up handkerchief or swab. If the bleeding does not stop please contact the department.
Gum recession: Because the gum is cut it can occasionally shrink back a few months after surgery as scar tissue forms. This is not normally a problem but if the tooth has been crowned the edge of the crown may become exposed.
Numbness: Lifting the gum to uncover the root of the tooth can occasionally lead to a numb feeling in the gum. This usually disappears after a few months.
Infection: Even if all the infection is successfully removed it can sometimes return months or even years later. If this happens it might be necessary to have the operation repeated but sometimes the tooth is better removed.

How will I feel after the procedure?
It is likely that there will be some discomfort and swelling both on the inside and outside of your mouth. There may be some bruising of the skin of your face. This is usually worse for the first couple of days, but it may take up to two weeks for complete recovery. You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so. Regular pain killers and anti-inflammatory will be helpful for the first few days. It may also be necessary to have a course of antibiotics after the procedure.

What should I do after the procedure?
It is important to keep the surgical site as clean as possible during the healing period. It may be difficult to brush your teeth around the sites of surgery as it may be sore. It may therefore be useful to gently rinse with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water). This should be commenced after 24 hrs.

How many days should I take time off work?
It may vary from few days to a week depending on how you recover and also the type of anaesthetic used. You should also avoid strenuous exercise during this time. Depending on the type of anaesthetic used you will not be able to drive (24 hours after intravenous sedation and for 48 hours after a general anaesthetic)

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