A tooth is kept vital, or alive, due to pulp material that travels from the bone and soft tissue, up through the roots, and into the root canal and its upper pulp chamber. The pulp can become inflamed when oral bacteria creates a dental infection. The inflammation can cause pain and dentin erosion that leads to cavities.
Pulp issues are normally corrected with root canal therapy, but that procedure isn't always enough to fully rid the tooth of infection. Your dentist or endodontist might then recommend an apicoectomy, which is the surgical removal of the apexes or root ends of the tooth.
Here are a few of the potential reasons a dentist, like Stephen P. Cary, DMD, might recommend an apicoectomy.
One of the most common reasons for an apicoectomy is an infection that returns even after a root canal procedure was already performed. The symptoms likely recurred because the infection was trapped in the hard to reach root apexes, which aren't targeted during traditional root canal therapy.
The dentist will need to cut into your gum tissue above the infected root, but you will receive a localized numbing agent before this happens. The dentist will then cut away any infected soft tissue surrounding the root and trim off the apexes. Cutting off the apexes still leaves an opening at the end of the root so the dentist will plug that opening with an expanding filling material. The filling keeps infectious material from entering through that route again.
Partially Blocked Root Canal
An apicoectomy is sometimes used as an ancillary procedure to a standard root canal if the canal has become blocked. The blockage is often caused by pulp calcification, which occurs due to trauma or, more commonly, due to the natural aging process. If a calcified pulp stone is in the middle of the pulp chamber, your dentist can only scrape out the upper pulp while performing the root canal.
The dentist might want to then follow up with an apicoectomy to ensure the other side of the canal is blocked from receiving any more infectious material. Your dentist will likely prescribe antibiotics to actually kill the active infection, but the combo treatment should keep the infection from coming back.
Infection in Tooth with a Crown
An apicoectomy might be scheduled instead of a root canal if the affected tooth already has an artificial crown in place. Your dentist would need to remove the crown to perform a root canal procedure and then a new crown would need to be placed. An apicoectomy can preserve the existing crown while sealing off the route for the infection.