WHY WOULD I NEED ENDODONTIC SURGERY?
In some cases, a tooth that has had a root canal, which did not sufficiently heal or has become re-infected, is not a candidate for endodontic retreatment. For these teeth, a minor surgical procedure that treats the infection from the root-end of the tooth, which is known as an apicoectomy, may be indicated. An apicoectomy is an excellent next step procedure to preserve a previously treated tooth, eliminate a dental infection, and to restore the health of the surrounding tissues. It is most useful in cases where fractures or hidden canals still cause pain or infection around a treated tooth, as well as when an endodontic retreatment procedure is not recommended as it will further weaken and jeopardize the tooth.
Often, the only alternative to endodontic surgery is the extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.
No matter how effective modern artificial tooth replacements are—and they can be very effective—nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.
An apicoectomy may be performed under local anesthesia. It is typically a straightforward procedure during which an incision is made in the gum tissue at the involved tooth. This is to expose the inflamed or infected tissue surrounding the root tip of the tooth. Once uncovered, the damaged tissue in the area is removed along with a few millimeters of the tooth’s root tip. A biocompatible filling material is then placed in the end of the remaining portion of the root to seal it and prevent any possibility of reinfection. The gum tissue flap is put back into place and sutured to complete the procedure.
Post-surgical discomfort is generally mild and you may have some swelling in the area. Most patients return to their normal activities very quickly. If needed, apply a cold compress to reduce discomfort and swelling after the procedure. The appropriate pain medication will be prescribed or recommended. If your discomfort does not respond to medication, or other symptoms that concern you develop, please call our office.
Prior to undergoing an apicoectomy the dentist will discuss all the risks and benefits of the procedure. If during the course of an apicoectomy any significant fractures are discovered in the tooth that changes the prognosis, you will be immediately advised.
FOR THE REMAINDER OF THE DAY:
1) Do not spit. Use a tissue to wipe your mouth as needed, or swallow your saliva. 2) Do not use a drinking straw. Drink straight from the cup.
3) Do not smoke.
4) Keep fingers and tongue away from the surgical area.
Spitting, the use of a straw, smoking, and poking can dislodge the blood clot that is forming, and will cause bleeding from the area. Also, smoking can increase the chances of an infection.
EATING:
You may eat soft foods as soon as the anesthetic wears off. Try not to chew directly on the surgical site. You may resume a regular diet as soon as you feel up to it. Please stay well nourished, and well hydrated, you will heal faster.
BRUSHING:
You may brush your teeth, avoiding the surgical area, either tonight or tomorrow morning. Be gentle, and do not spit or rinse forcefully. Start brushing the surgical area on the second day, and be very gentle on the stitches.
RINSING:
You may start rinsing today, gently, with some warm salty water every few hours. Do not use alcohol-containing mouth rinses for a few days.
MEDICATIONS:
You were probably given one or more prescriptions for medications. Take all medications with a full glass of water, and as directed on the bottle. Call us if you experience severe nausea, or diarrhea, or cannot swallow your pills.
1) Antibiotics: Continue until the bottle is empty -- Do not quit halfway.
2) Pain Medicine: Continue as necessary. Remember that narcotics can make you drowsy, so no driving, operating machinery, or alcoholic beverages while you are taking them.
FOR BLEEDING:
Some minor bleeding is expected after apicoectomy. It will usually subside quickly, and stop within an hour or two after surgery. A little oozing is normal and may persist for several hours.
1) Keep gauze on the surgical area with some pressure for 30 to 45 minutes.
2) Remove the gauze after 30 to 45 minutes, and replace it with a new piece of gauze if you are still bleeding. It is important to make sure the gauze is directly on the surgical site. Firm pressure for another hour should stop the bleeding.
3) If you find that this is not working after your third attempt, use a moistened tea bag instead of the gauze. The tannic acid in tea will help to form a clot and stop the bleeding.
4) If all else fails, call the office.
FOR SWELLING:
Most patients will experience some swelling after surgery in the mouth. It may be mild or severe, and is different for every patient. The swelling will get bigger for the first 24 to 48 hours before it starts to go away. It may last for several days to one week.
1) Use an ice pack on the cheek or face next to the surgical site. Keep it on for 15 to 20 minutes, then off for 10 minutes, and repeat until you go to sleep. Start again the next day.
2) Sleep with your head elevated slightly above the heart. This will keep swelling down.
3) On the third day, change to moist heat instead of ice packs. This will bring the swelling down quicker.