Apicectomy: execution and post-intervention

What is apicectomy?

Apicectomy is an invasive dental procedure that involves removing the infected apex of a dental root.

If the infection cannot be treated by simple devitalisation, apicectomy is the first-line surgical procedure for restoring granulomas, cysts and dental abscesses.

Despite being relatively simple and almost painless, an apicectomy intervention still requires the qualification of the operator and the collaboration on the part of the patient.

In the continuation of the article we will describe with precision all the phases of the apicectomy; subsequently, we will answer frequent questions and doubts in order to drive away, as much as possible, the typical pre-intervention tension.

Intervention

Apicectomy is a rather simple surgical practice: after anesthetized the diseased tooth, it is possible to proceed with the removal of the infected mass from the root apex.

The main phases of the intervention are described below:

1. After putting the tooth to sleep with local anesthesia, the doctor makes an incision directly into the gum: in doing so, the underlying root is completely exposed
2. The infected tissue is removed by special surgical instruments
3. The last millimeter of the root is removed (the root is left "uncovered")
4. Apicectomy proceeds with the meticulous disinfection of the treated area to reduce the bacterial load: by doing so, it is possible to prevent further, possible, infections
5. The next step is the filling of the root apex: the end of the root - whose tip has been removed - must be sealed with a biocompatible material to deny access to the bacteria. This operation is called retrograde sealing or filling
6. Apicectomy ends with the perfect repositioning of the gingival flaps: the gingiva must be sewn up with appropriate stitches

Stitches that do not dissolve should be removed by the doctor 2-7 days after surgery.

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Duration of the intervention

The duration of the procedure generally varies from a minimum of half an hour to a maximum of 90 minutes, depending on the tooth to be treated, the severity of the lesion and the complexity of the root structure of the tooth.

Risks and complications

Being a surgical operation, apicectomy can create discomfort or pain in the days following the surgery. The most common symptoms reported by patients undergoing apicectomy are:

• Pain and swelling (more pronounced the day after apicectomy)
• Numbness of the gingiva in the dental semi-arches in which the operation was performed
• Masticatory difficulties
• Gingival bleeding
• Dental sensitivity
• Need to resort to tooth extraction in case of maladjusted apicectomy

A significant risk is the malorientation of the intervention: in case of failure, the only conceivable option to correct the error consists in extracting the tooth. The success of the intervention in the long term is essentially given by the specialist's ability to perfectly seal the root apex, so as to guarantee a certain protection from possible bacterial attacks.

From here we can understand how important it is to rely on highly qualified and experienced doctors.

However, a perfectly performed apicectomy is generally a permanent solution.

After apicectomy

To speed up wound healing and minimize post-apicectomy pain, the doctor will have to educate the patient on the correct behavior to keep: observing some simple precautions can, without a doubt, favor a faster recovery, minimizing the appearance of complications.

The following are general guidelines to be observed after apicectomy:

• To calm the pain when the effect of anesthesia wears off, it is recommended to place an ice bag (wrapped on a soft cotton cloth) on the outside of the jaw, in line with the intervention site.
• Take anti-inflammatory drugs regularly (eg ibuprofen) in the 5-6 days after apicectomy: continuous administration of NSAIDs minimizes pain and reduces swelling in a short time. Particularly suitable for keeping pain at bay is ibuprofen (eg Brufen, Moment): it is recommended to take the drug by mouth at a dose of 200-400 mg (tablets, effervescent sachets) every 4-6 hours after meals, as needed. Do not take more than 2.4 grams per day.
• If necessary, take an antibiotic as a precaution to reduce the risk of infection: follow the instructions given by the doctor. The antibiotic can only be taken with a prescription.
• Gently rinse the mouth with disinfectant mouthwashes (eg chlorhexidine 0.2%) only 12-24 hours after apicectomy. Continue rinsing for at least two weeks after surgery
• Follow a soft diet, consisting of soft foods such as mashed potatoes, warm soups, warm soups, smoothies, minced meat, baby food, puddings, meatballs, boiled fish, etc.
• Observe complete rest for 2-3 days after surgery
• Do not vigorously brush the gum subjected to the operation to avoid damaging the still sore and swollen area. Prefer a soft bristle toothbrush; the use of the water jet instead is not recommended ..
• Do not lift the lip corresponding to the apicectomy tooth to avoid loosening the stitches on the gum

After 6 months / a year after apicectomy, the patient should undergo a radiographic check to verify the success of the dental operation in the long term. If even a year after surgery the conditions of the tooth that underwent apicectomy are optimal from a conservative point of view, the chances of granuloma recurring are extremely scarce. More generally, a perfectly successful apicectomy guarantees an extraordinary (and permanent) coverage from apical infections in general.