Apicoectomy: How successful is root-end surgery?

In this detailed guide to apicoectomy surgery, highly esteemed specialist endodontist Mr Corneliu Gherasim offers expert insight on when the procedure is required and how it is performed. The renowned specialist also sheds light on the success rates of apicoectomy surgery and how the use of advanced surgical techniques and technology positively impact patients’ recovery.

What is the aim of apicoectomy surgery?

Apicoectomy is also known as a root-end surgery or root-end resection. It’s a minor surgical procedure which we usually perform under local anaesthetic, although sometimes anxious patients may require intravenous sedation.

Patients with persistent infection of an endodontic nature, where a primary and secondary root canal treatment has failed may require an apicoectomy. Additionally, it may be necessary in cases where following one unsuccessful root canal treatment, a second is not possible. This may be because it is not possible to access the root canal in order to perform a root canal treatment due to large endodontic posts or the risk of rendering the tooth non-restorable.

How is apicoectomy surgery performed?

During the procedure, the gum is lifted to expose the infected area and the tip of the root is then removed, together with some bone and infected tissue. The root canal can then be cleaned from the top and sealed with specific restorative materials. Finally, the gum is repositioned using sutures which are usually removed three to five days after the surgical procedure.

What is the recovery period like following apicoectomy surgery?

This is a very conservative and precise treatment approach. From the moment we begin the procedure by administering the local anaesthetic until the moment we finish by putting in the sutures, the microscope is used continuously, which has an immensely positive impact on post-intervention pain levels.

This procedures is far less invasive than more traditional methods, particularly with the bone, and this fact, along with the help of the microscope, allows us to achieve much better control of the soft tissue. Being less invasive causes less trauma, resulting in far less pain following the procedure. Therefore the vast majority of my patients only experience mild to moderate pain in the twenty-four to forty-eight hours following surgery.

Sometimes there is mild to moderate swelling but usually patients are ninety per cent recuperated on day five when the sutures are removed. The outcome of the procedure will be reviewed at six and twelve months post-surgery. Most often, this review is informed by plain radiographs or by means of a CT scan.

What are the success rates of apicoectomy surgery?

In current apicoectomy surgery, we use modern, specifically made materials to seal the root canals as well purpose-built instruments and the aid of the microscope. Thanks to these advances, the procedure’s success rates have increased to around ninety per cent, compared to fifty per cent in traditional apicoectomy surgery.

Generally, it is very unusual for an apicoectomy to fail, especially once a favourable outcome has been confirmed using radiography at the six or twelve month review.

What are the next steps when apicoectomy surgery fails?

Although the chances of failure are quite slim, I usually advise patients to have the procedure redone, especially in cases where the surgery was done in a traditional manner, which can be observed using radiographic inspection.

Although the success rate with our current approach is much higher, sometimes surgeries do fail and most of the time the cause is structural, resulting either in cracks or root fractures. In cases of structural failure, the tooth will most probably need to be extracted and replaced with either a single implant supported crown or a bridge.

If you require apicoectomy surgery or are unhappy with the results of a previous procedure and wish to schedule a consultation with Mr Gherasim, you can do so by visiting his Top Doctors profile.