2 May 2011 | Treatments

If, despite root canal treatment, the granuloma persists, an apicectomy must be performed

In an apicoectomy, or surgical removal of the tip of the root of the tooth along with a granuloma, which developed as a result of bacterial infection in the supporting bone of the tooth. An apicoectomy is carried out when traditional removal of the infected nerve of the tooth is not possible, but also when devitalisation, an endodontic treatment failed. Endodontic treatment, or root canal treatment or devitalisation is one of the most difficult treatments to be carried out inside the mouth. Every tooth has a nerve, which consists of a main canal with many branches. The latter can create problems as it is very difficult to disinfect them because they cannot be reached with tools, irrigation, ultrasounds or laser. Furthermore, in case of anatomical limitations such as very curved or sclerotic or obstructions, canal treatment may have incomplete results. Even after an apparently successful endodontic treatment, a tooth may, after some years, develop a granuloma at the tip of the root. It is usually caused by very resistant bacteria (gram-positive, E. faecalis) that nest in the branches and have not been removed during primary endodontic treatment.

Apicoectomy is performed using local anaesthesia. We will use piezosurgery to create access to the lesion in the bone, followed by dental laser, which removes all bacteria along with the diseased tissue and the tip of the tooth. Retrograde sealing might be performed on the root. X-rays will be taken after 6-12 months to evaluate the success of the treatment.

When a tooth has a very short root, or in the event of root resorption due to the granuloma, apicoectomy is contraindicated and tooth extraction and, at a later time, implantation should be preferred. Together with you we will carry out a very accurate evaluation of cost, benefits, prognosis and other treatment options within the entire treatment plan for your dental needs.