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Apicoectomy

Offering Apicoectomy Services for Stamford, CT & the Surrounding Area

If you have recently undergone root canal treatment and are still experiencing pain or an infection that won’t go away, it may be necessary to visit an oral surgeon and undergo an apicoectomy. Caring for patients throughout Stamford, Norwalk, Westport, CT and the surrounding areas, when you visit Premier Oral Surgery, Dr. Simon Y Bangiyev will perform an exam and discuss your oral history to determine if this procedure is right for you.

What is an Apicoectomy?

A root-end surgery, also known as apicoectomy is an endodontic surgical procedure designed to save a tooth after one or more attempts at root canal treatment. The goal of this surgical procedure is to allow patients to preserve their natural tooth rather than have it extracted.

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip or end of each root is called the apex. During root canal treatment, your dentist cleans the canals using special instruments called files. Inflamed or infected tissue is removed.

As root canals can be very complex, with many tiny branches off the main canal, sometimes infected tissue can remain in these branches. This can possibly prevent healing or cause re-infection later. If the infection persists or won’t go away after retreatment, an apicoectomy may be necessary.

This is where our oral surgeon can help. During the apicoectomy, the root tip or apex will be removed along with the infected tissue. Once the root tip is removed, the root end cavity is then prepared and filled with a biocompatible material. A filling is then placed to seal the end of the root.

When Should I Have My Tooth Checked?

If you’re having any pain or swelling from a tooth that has had root canal treatment, you should contact your dentist to discuss your concerns. Warning signs can include a pimple or abscess that develops near the affected tooth. This pimple will often go away and then come back. This is called a fistula. You may notice pus draining from the fistula. This is a sign that there is an infection and your body is draining it out through the pimple. There is usually no pain in this situation, but you may notice a bad taste or odor in your mouth caused by the infection.

When Would I Need An Apicoectomy?

An apicoectomy is typically only done as a last resort after a tooth has had at least one root canal procedure and retreatment has not been successful or is not possible. For example, retreatment is often not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this. An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

How Can I Prepare for the Procedure?

Before the procedure, you will have a consultation with your dentist who may then refer you to an oral surgeon. Before the surgery, your dentist may take more X-rays of the tooth and surrounding bone. To help with an underlying infection, you may be given an antimicrobial mouth rinse, as well as medicine to reduce inflammation, and/or antibiotics. Your dentist also will review your medical history. Make sure you tell your dentist of all medicines you take. This includes over-the-counter medicines, vitamins and supplements.

What Should I Expect During the Procedure?

During the oral surgery, Dr Simon Bangiyev will make a small incision (cut) in your gum and lift the gum away from the tooth and bone. The infected tissue will be removed along with the last few millimeters of the root tip. If the tooth has large cracks or breaks, it may need to be extracted. In this case, the apicoectomy will not continue. If the tooth is intact and there are no further complications, our oral surgeon will complete the procedure by cleaning and sealing the end of the tooth’s canal. One of our assistants then will take an X-ray of the area before stitching the tissue back in place. Most apicoectomies take 30 to 90 minutes. The length of surgery will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

What Should I Expect After the Procedure?

Once the procedure is complete, Dr Simon Bangiyev will tell you which medicines to take and what you can eat or drink to help ensure the healing process goes smoothly.

It is not uncommon for the area to bruise and swell. To help with subsequent swelling that may occur, you can apply ice to the area, alternating 20 minutes on and 20 minutes off. Do this for 10 to 12 hours after the surgery, and rest during this time. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and others). In some cases, you may be given a prescription for pain medicine. If so, follow the instructions for taking it.

To allow for healing, avoid brushing the area or rinsing vigorously. Don’t smoke or eat crunchy or hard foods. Do not lift your lip to examine the area. This can loosen the stitches and disrupt formation of the blood clot that is needed for healing. Patients may also experience some numbness in the area for days or weeks after the oral surgery. While the numbness usually goes away with time, you can still reach out and let your dentist know of any discomfort you are feeling.

Depending on the type of stitches used, they may need to be removed 2 to 7 days after the procedure, or they may dissolve by themselves. All soreness and swelling are usually gone within 14 days following treatment.

What Are Some of the Risks?

During your initial consultation at Premier Oral Surgery, Dr Simon Bangiyev will review the risks of the procedure. Make sure to ask questions if something the dentist has told you is not clear. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be additional risks that our oral surgeon will discuss with you. For instance, if the tooth is in the back of your upper jaw, the infection can involve your sinuses. if this is the case, your dentist may suggest or prescribe antibiotics and decongestants.

The roots of the back teeth in the lower jaw are close to some major nerves. Oral surgery on one of these teeth carries a slight risk of nerve damage. However, your oral surgeon will use your X-rays to determine how close the roots are to the nerves and access the risk. In most cases, the chances of nerve damage are extremely small.

In most cases, undergoing an apicoectomy is effective and offers patients a permanent solution that should last for the life of the tooth. If you live in Westport, Norwalk, Stamford, CT or the surrounding areas and are looking for an oral surgeon with experience performing this procedure, do not hesitate to reach out to our office today.

For further information, contact Premier Oral Surgery to schedule a consultation.

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