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Apicoectomy

 

Apicoectomy (Apico) is a procedure to salvage a failing root canal. The procedure is performed mainly by oral surgeons. Dr. Muduli recommends the use of I.V. general anesthesia since the procedure can take up to an hour to perform. The apico has a success rate of 70-80%. Below is an panorex radiograph of a patient who needed 2 apico's on her posterior molars.

 

The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars tend to have several roots, whereas the front incisors only have a single root. The end or tip of each root is termed the apex. The apex is where the nerves and blood vessels enter the tooth, and aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.

Reasons for an apicoectomy

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating to the patient. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicoectomy will rarely be considered by the dentist unless a prior root canal treatment has failed.

There are several reasons why an apicoectomy may be necessary:

  • Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
  • Blocked Root Canal – In some cases, the dentist is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. Infection and debris can quickly affect adjacent teeth.
  • Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.

What does getting an apicoectomy involve?

Prior to the surgery, the dentist will generally prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection. Panoramic x-rays will then be taken to enable the dentist to plan the apicoectomy, which will be performed under local anesthesia.

The dentist will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material) and the dentist will suture the gum with several stitches.

This surgery does not require an overnight stay, and full aftercare instructions and pain medications will be provided as needed. After several days, the dentist will remove the stitches, and the connective tissues will fully heal several months after the procedure.

If you are experiencing any signs or symptoms, such as pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately to schedule an appointment.

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Testimonials

Dear Dr. Muduli ,

I want to take this opportunity to thank you for the excellent care and attention given to me during my office visit. I really appreciate your kind consideration and review of my medical condition. The time taken to explain to me the various options and your expert opinion is greatly appreciated. You have demonstrated to me your wisdom and knowledge of the profession. Once again, thanks for helping me and giving me high quality care and attention.

Peter

Dear Dr. Muduli,
I will write to you with warm and sincere thanks for extracting my wisdom teeth. I must say that you exemplify a superior level of professionalism, proficiency and confidence when you work. I was initially very apprehensive at the start of the procedure. However you and your staff were able to relax and provide me reassurance. You performed outstandingly and for that I am very grateful.
Please know that I will proudly recommend you to anyone that I should encounter who may require your services. You exhibit truly iconic poise and are a model to be replicated. Despite this, I do sincerely hope I never have to see you again. Once more, my deepest thanks and best regards.

Christopher

Top qualities: Great Results, Expert, High Integrity

“The quintessential professional in his field; Dr. Muduli's attention to detail, his superior skill, and unparalleled bedside manner make him a rare find in a competitive and sometimes confusing arena of Oral & Maxillofacial Surgery. My first experience with his professionalism and skill was when Dr. Muduli's comforting and professional approach put my son at ease while treating him for a difficult procedure to remove significantly impacted wisdom teeth. At the time his practice was local to me. The results were excellent. I was so pleased with how he cared for my son that when I needed extensive maxillofacial treatment I made the trip to his new office 23 miles from my home. A worthwhile trip I would readily do again. Bobby is a health professional I trust with my children and will gladly go out of my way in terms of travel for his services. I highly recommend him.” November 8, 2011

Francis

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