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Peri-radicular surgery

Infection can persist at the tip of the root on one or more teeth. Previously these teeth may have had an abscess and have been root– treated. This persistent infection does not always cause any symptoms. Sometimes, you can have acute pain, but more often, just some discomfort and occasional episodes of swelling, a gumboil or a bad taste. A course of antibiotics may have been prescribed to try to control the infection, but antibiotics are not a permanent cure.

Why do I need treatment?

  1. Peri-radicular disease associated with a tooth where iatrogenic or developmental anomalies prevent non- surgical root canal treatment being undertaken.
  2. Peri-radicular disease in a root- filled tooth where non- surgical root canal re-treatment cannot be undertaken or has failed, or when it may be detrimental to the retention of the tooth (eg obliterated root canals, teeth with full coverage restorations where conventional access may jeopardise the underlying core, the presence of a post whose removal may carry a high risk of root fracture).
  3. Where a biopsy of peri-radicular tissue is required.
  4. Where visualisation of the peri-radicular tissues and tooth root is required when perforation or root fracture is suspected.
  5. Where it may not be expedient to undertake prolonged non surgical root canal re-treatment because of patient considerations.

What does treatment involve?

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 end with a small filling. It is necessary to make a cut in the gum over the root of the tooth or around the gum margin of several teeth. The gum is then lifted from bone. The area of infection is accessed by removing a small amount of bone over it with a drill. Any infected tissue is thoroughly cleaned away from the tip of the root before removing some of the root tip. The root end is then sealed with a small filling. The gum is then stitched back into place with dissolvable stitches that take around two weeks to disappear. Alternatively, your dentist or surgeon may choose to remove them earlier. The whole procedure may take up to an hour to complete.

What type of anaesthetic is used?

Usually an apicectomy is carried out under a local anaesthetic, i.e. an injection into the gum that numbs the area. This anaesthetic will prevent you feeling any pain during the procedure. If you are particularly anxious your surgeon may recommend you have some type of sedation. If the area of infection around the root is very large, or there is a large cyst around the root, or several teeth need operating on; a general anaesthetic may be necessary.

What can I expect after the operation?

When the local anaesthetic wears off a few hours after surgery there will be some discomfort. Your surgeon will discuss painkillers with you. Antibiotics are not usually needed. The discomfort should ease after a few days but may take a couple of weeks to completely resolve. You may require a day or two off work during which time you should avoid strenuous exercise. Some swelling can occur both inside and outside the mouth after surgery. This is usually most noticeable for about two days. It is important to keep the site of surgery as clean as possible for the first few weeks after surgery. If it is difficult to use a toothbrush the area can be kept free of food debris by gently rinsing with a salt water mouth wash (dissolve a teaspoon of kitchen salt in a cup of warm water). Start on the day after surgery. Do it as often as you can, but especially after eating.

What are the possible outcomes?

  1. Successful (clinical- No signs and symptoms, radiological- normal PDL, osseous pattern, lamina dura, no root resorption).
  2. Incomplete (clinical- No signs and symptoms, radiological- partial regeneration of periapical bone).
  3. Uncertain (clinical- Vague symptoms: mild discomfort, feeling of pressure, fullness around tooth, radiological- partial regeneration of periapical bone.
  4. Unsuccessful (clinical- presence of signs and symptoms. Radiological- No regeneration of periapical bone)
  • Further surgery generally associated with lower success rate (35.7%)


For more information regarding this treatment

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