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Apicectomy & Periradicular Surgery

 LONDON

Periradicular surgery provides a crucial alternative when conventional root canal therapy fails to fully resolve issues of infection surrounding the root tip of a tooth.

This intricate surgical procedure necessitates the removal of the diseased root tip and a subsequent meticulous suturing of the gum tissue back to its original position.

The discussion that follows aims to dissect the various aspects of this procedure, including its necessity, the detailed steps involved, the post-operative care, and the success rates associated with it.

Key Takeaways About Apicectomy | Periradicular Surgery.

  • Periradicular surgery treats infections around the tooth root when conventional root canal treatment has been ineffective.
  • It is performed when conventional root canal treatment has failed.
  • The apicectomy/periradicular surgery involves removing the infected root tip and sealing the root canal.
  • Factors such as the clinical skills of the endodontist, root filling quality, and orthograde root canal treatment influence the success rates of periradicular surgery.

What is Apicectomy?

An apicectomy, is a common dental procedure that involves the removal of the inflamed gum tissue and the end of the tooth root, specifically focusing on the tip of the root.

This surgical procedure, also known as periradicular surgery, is performed when a periapical lesion persists after conventional root canal treatment. The root end is exposed and resected, followed by the preparation of a root-end cavity which is then filled with a biocompatible root-end filling material to prevent bacterial leakage.

This periapical surgery is aimed at preservation of the tooth, and is an effective method of dealing with infections and inflammation in the root tip.

What is the difference between root canal treatment and apicectomy?

Apicectomy, or periradicular surgery, involves removing the infected root end. It is generally performed after a root canal therapy has failed to resolve the infection.

On the other hand, a root canal treatment, a common endodontic treatment, involves removal of the infected pulp from the root canal system without surgery.

While both procedures aim to retain the tooth, apicectomy is more invasive and is typically considered when a root canal has not provided the desired results.

What is Periradicular Surgery?

Periradicular surgery is an umbrella term that covers:

  1. Apicectomy (see above).
  2. Repair of perforations. These occur when there is a communication between the root canal system and the periodontium or the oral cavity. This can either happen as a complication of root canal treatment OR root resorption (side effect of dental trauma).
  3. Management of extruded root filling.
  4. Surgery to explore root fractures.
Periradicular Surgery Involves Outcome of Periradicular Surgery
Removal of infected root tip Often successful, improving oral health
Sealing of root canal Contributes to the patient’s comfort
Treatment of infections around the root Prevents further dental complications
Procedure when root canal treatment has failed Resolves persistent dental infections

Periradicular Surgery Steps

The periradicular surgery steps  are as follows:

  1. Detailed history and examination (including x-rays) results in a full assessment of all the risks of the procedure can then be discussed so that you are fully informed before the procedure.
  2. Local anaesthesia is achieved with nerve blocks (using lidocaine containing a vasoconstrictor) or infiltrations with articaine.
  3. Incisions in the gum to allow the removal of the gum from the bone which exposes the area to be repaired.
  4. If the purpose of treatment is the apicetomy, the root tip is then removed (leaving the root filling exposed).
  5. Removal of the diseased and infected tissue  which is sent to the laboratory for histopathological investigation.
  6. The exposed root filling is then sealed with a biocompatible material. This is usually mineral trioxide aggregate (MTA) which is a biocompatible substance that promotes healing.
  7. Placement of sutures. If dissolvable stitches are used, they will dissolve within 2 weeks.

The success of periradicular surgery hinges on the precision and attention to detail in each step.

Periradicular Surgery Aftercare

After meticulously executing the various steps of periradicular surgery, attention must be turned to the critical period of aftercare to ensure optimal healing and minimise discomfort. The aftercare plan focuses on pain management and the prevention of persistent periapical complications:

  • Taking prescribed medications, typically ibuprofen and/or paracetamol for 2-3 days after surgery.
  • In case of excessive bleeding, use a tea bag or gauze to apply pressure.
  • Soft diet for 3-7 days.
  • Mouth washing with a chlorhexidine-based mouthwash until the sutures are removed.
  • Review appointment in 2 weeks after surgery to remove sutures.

The success rates of periradicular surgery depend significantly on the quality of the root canal filling and the filling materials used during the procedure. Proper aftercare is crucial, especially if previous surgical attempts have been unsuccessful.

Success Rates of Periradicular Surgery

Studies indicate that the success of periradicular surgery is promising, with a survival rate reaching up to 82.46% in a 5-year span post-surgery.

The strategy for successful periradicular surgery include elements such as specialist endodontic skills and meticulous excellent root filling. However, the presence of periapical radiolucency or need for re-treatment or periradicular surgery can impact outcomes.

Mandibular molars and older age groups have been associated with a higher risk of extraction. Thus, while the periapical health of the tooth is integral, patient-specific factors also play a pivotal role in determining the success of periradicular surgery.

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Apicectomy & Periradicular Surgery FAQ

What are some signs and symptoms that may indicate the need for periradicular surgery?

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Signs and symptoms that may warrant periradicular surgery include persistent swelling around the apical region, radiographic evidence of periapical lesions, and symptomatic apical pathology that does not respond to non-surgical interventions.

What Is a Periradicular Surgery?

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Periradicular surgery, or apicectomy, is a dental procedure performed when a root canal treatment fails. It involves removing the infected root tip, stitching the gum back, and providing aftercare to prevent further infections.

What Does Periradicular Mean?

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The term “periradicular” pertains to the area surrounding a tooth root. In dental terminology, it refers to the tissues that envelop and support the root of a tooth, including the periodontal ligament and alveolar bone.

What Is the Prognosis for Periradicular Surgery?

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The prognosis for this type of surgical procedure is generally positive, with successful outcomes often resulting in symptom resolution and reduction of periapical radiolucency. Modern techniques contribute to higher success rates and improved patient outcomes.

What Is a Periapical Surgery?

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A periapical surgery, or apicectomy, is a dental procedure aimed at removing the infected tip of a tooth root. This surgery is typically performed when endodontic treatment fails to resolve an infection around the root tip.

What is periradicular surgery?

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Periradicular surgery, also known as apical surgery, is a dental procedure performed at the tip of a tooth’s root to treat persistent infections or inflammation in the surrounding tissues.

When is periradicular surgery recommended?

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Periradicular surgery is recommended when non-surgical root canal treatment has failed to resolve the issue, or in cases where a retreatment is not feasible. It is also considered in cases where an apical lesion persists despite previous treatment.

What are the contraindications for periradicular surgery?

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Some contraindications for periradicular surgery include extensive root resorption, inadequate bone support, and the presence of a root fracture that cannot be repaired. It is important to consult with a dental professional to determine individual contraindications.

What are some treatment outcomes associated with periradicular surgery?

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Treatment outcomes of periradicular surgery may include the resolution of periapical lesions, improvement in symptoms, and the preservation of the natural tooth when successful. However, individual outcomes may vary.

What role does the Royal College of Surgeons play in periradicular surgery?

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The Royal College of Surgeons may provide guidelines and recommendations related to periradicular surgery, contributing to the advancement of clinical dentistry within the field of endodontics and oral surgery.

What are the prognostic factors for periradicular surgery?

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Prognostic factors for periradicular surgery include the presence of apical pathology, the quality of the root canal filling, and the condition of the surrounding bone and tissues. These factors can influence the success of the surgical procedure.

What is the significance of endodontic microsurgery in periradicular surgery?

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Endodontic microsurgery involves the use of advanced magnification and illumination techniques to perform precise surgical interventions in the apical region, enhancing the success rates and minimizing disruption to the surrounding oral tissues.

What are the treatment options for managing apical lesions?

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The management of apical lesions may involve non-surgical root canal treatment, periradicular surgery, or in some cases, the consideration of dental implants as a potential treatment option. The choice of treatment depends on the individual clinical scenario.

How can general dental practitioners contribute to the understanding of periradicular surgery?

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General dental practitioners can enhance their understanding of periradicular surgery through continuous education, collaboration with endodontic specialists, and staying updated with the latest systematic reviews and guidelines from reputable sources.

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