What is an Apicoectomy?

An apicoectomy, also known as an apico, is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. An apico is done only after a tooth has had at least one root canal procedure and re-treatment has not been successful or is not possible.

What conditions would require an Apico?

  • An uncleaned root canal blocked by fractured file that cannot be removed.
  • A badly curved root canal obstructing endodontic files from reaching the root tip.
  • Several small branches at the sides of the root canal that cannot be cleaned and sealed.
  • Other conditions that obstruct healing after a root canal treatment.

What is the Procedure?

In this procedure, the surgeon opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root of the tooth is also removed. A small filling will be placed in the root to seal the end of the root canal, and the gingiva is repositioned and sutured.Over a period of months, the bone heals around the end of the root.

What is the Success Rate of an Apico?

The apico has a success rate of 70-80%.

What are the other Treatment Options with a Failing Root Canal?

  • Option 1- Extract the tooth.

There is no substitute for a natural tooth. If the tooth can be saved, we would recommend saving it. Once the tooth is extracted, the tooth in most cases should be replaced, i.e. dental implant and crown, removable denture, or a fixed (cemented) bridge.

  • Option II- Retreat the tooth with a root canal.

Re-treatment is often not a good option when a tooth has a crown or is part of a bridge. Re-treatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. Also, most canals fail, not because of poor treatment, but because of anatomic peculiarities about the particular canal system that make treatment with traditional techniques difficult or impossible. Those peculiarities are still present, however, and because of this re-treatment, often have a relatively low success rate.