Frequently asked questions about apicectomies

What is an apicectomy?

An apicectomy is a minor procedure to remove the tip (apex) of the root of a tooth. This will be done in association with the root treatment of the tooth (to fill the canal of the root and to treat or prevent infection).

Sometimes, apicectomies also involve the removal of a cyst at the top of the tooth root. Apicectomies are more often performed for front teeth (they are easier to access) but can be carried out on back teeth.

Why can't antibiotic treatment alone be used on infected cysts?

Antibiotics will usually help the pain and swelling associated with acute dental infections. However, they are not very good at reaching into infected cysts (or abscesses) and killing all the bacteria that are present.

Dentists and oral and maxillofacial surgeons will want to remove infected tissue as soon as it is practically possible, to remove the source of infection and prevent future problems. They might use antibiotics to help them do this, but the physical removal and stopping of potential places for bacteria to hide and grow is very important.

What are the other options?

Dentists prefer to conserve the teeth and associated tissues. They will give you various options to consider starting with the least destructive (most conservative). These can include apicectomies and root treatments.

For some buried teeth associated with dental cysts the best treatment is to remove (extract) the tooth. Some people will prefer the extraction of a dead tooth with a dental cyst at its root and replacement with a fixed (bridge) or removable (denture) tooth.

How are apicectomies performed?

Apicectomies are usually carried out under local anaesthesia (while you are awake). The dentist (or oral and maxillofacial surgeon) will need to gain access to the tip of the root, which means that they will make an incision in your gum (a 'flap') with a scalpel and then might need to remove some bony tissue (some drilling to remove a 'window'). The root tip of the tooth is then removed (by drilling) along with the infection or cyst (scooped out with an instrument), then a small white filling is placed at the end of the tooth to seal it. The flap of gum is then replaced and held in place with dissolving sutures (stitches).

How long does it take to heal after the apicectomy?

The sutures disappear usually within two weeks and over time the bony window heals up under the gum. If the procedure is successful, it takes about six months for some bone to replace the cavity where the root tip and cyst were removed.

Who usually does apicectomies?

General dentists are trained to do apicectomies but some, who perform them only rarely, will prefer to refer their patients to an oral and maxillofacial surgeon.

There might be other reasons why an apicectomy might be preferable to be performed by an oral and maxillofacial surgeon other than your general dentist eg if the patient is very young and would need either sedation or a general anaesthetic or if they have other medical problems. Your dentist will be able to advise you of your treatment options.

How will I feel after an apicectomy?

You will be given careful after care instructions. In general, the area that has been operated on will feel sore and you should expect some swelling to occur.

Usually, you will be prescribed some antibiotics to prevent or treat any dental infection. Your usual painkillers should be effective but if you have unpleasant pain, it would be a good idea to check back with the dentist or oral and maxillofacial team for advice.

To prevent mouth infections and for your own comfort, it is most important to keep the area clean: on the following day, rinse your mouth with antiseptic or warm salty mouthwashes and start to brush the teeth and gums gently.