Exodontia.Info
Apicectomy & Retrograde Root
Filling (RRF)
Warnings
An apicectomy (also known as surgical endodontics,
apical surgery or peri-radicular surgery) should be
considered only when conventional
endodontic root
filling
or re-treatment (root canal treatment) techniques
have failed.

This list is not exhaustive nor is it predictive.

The most pertinent warnings have been included here.  You
can expect the following.

Apicectomy & RRF / Endodontic Surgery-Specific
Warnings

No / Incomplete Root Canal Treatment Reduces Operation
Success
.  If the tooth that is being operated on has no /
incomplete root-canal filling than the operation success is
much reduced.  Ideally, the tooth should be root-canal
treated (well) before it has an apicectomy.

Anatomical Considerations.  Certain teeth (such as
premolars / bicuspids, molars & lower incisors) can be
more tricky to treat and consequently, the success rate is
not as high as one would hope.  This is due to the anatomy
of the tooth (e.g upper
premolars have multiple canals
within roots that may not have all been filled) and the
anatomy of the mouth (e.g proximity to nerves & sinuses;
thickened bone overlying the operation site; cheek bone
buttresses hampering access and overactive muscles of
facial expression again hampering access).

Operation Failure.  The operation can sometimes fail (80 -
96% chance of success).  If so, it can be repeated however
the chances of success become progressively smaller each
time the operation is done anew (2nd time around, success
rates drop to 30 - 35%).

Root Fracture.  Sometimes, it is not until the gum is peeled
back & the root is in front of the surgeon that it will be
noticed there is a root fracture.  If this is the case, the tooth
can not be salvaged.  If this should happen, you will be
given an option to have the tooth removed then & there.

Increased Tooth Mobility.  If the root tip is removed, as in
an apicectomy, there is a consequent reduction in the root
area of the tooth in contact with the bony socket.  This has
the effect of making the tooth very slight mobile.  The more
a tooth tip is cut back, the more mobile the tooth will be
after the operation.

Gum Recession.  Often the tooth being operated is
crowned/capped.  After the operation, the gums will recede
from the margins of the cap / crown.  The recession is likely
to worse if the tooth is in proximity to a frænum, a fibrous
band linking the gum to the lips or cheek.  The recession
can be such that you may even consider having a new
crown made with the crown margins hidden below gum-
level.

Involvement Of Nerves & Subsequent Nerve Trauma.  The
nerves that supply feeling to the tongue, lower lip and the
chin run close to the root-ends of the molar teeth and exit
onto the gum close to the roots of the premolars / bicuspids.

There is a risk that when lower teeth (especially the
molars
&
bicuspids / premolars) have endodontic surgery, these
nerves can be affected, resulting in numbness (at the worse
end of the scale) to altered sensation (at the other end of
the scale) in the region of the lower lip ± chin ± tongue.  The
nerves that supply feeling to the upper lip & gum run within
the upper gums.

On operating on upper front teeth, these nerves can be
affected resulting in numbness of the gum surrounding the
tooth (though not the upper lips).  This improves with time,
should it occur.  Alterations in nerve function tends to be
temporary (rarely are they permanent) but ‘temporary’ often
means several months.

Adjacent Teeth.  The surrounding teeth may be sore after
the operation; they may even be slightly wobbly but the
teeth should settle down with time.  It is possible that the
fillings or crowns of the surrounding teeth may come out,
fracture or become loose.  If this is the case you will need
to go back to your dentist to have these sorted out.

Sometimes, in trying to apicect the tooth in question, the
blood supply to the surrounding teeth may be
compromised.  This can lead to the death of adjacent teeth;
if this is the case, they may need endodontic treatment.

Mouth-Sinus / Mouth-Floor of Nose Communications.  
Upper back teeth often have their roots in close proximity to
the
floor of the nose or the sinus.  In operating on the ends
of these teeth, there is a chance that the sinus will be
perforated (10 – 50% of cases).  After the apicectomy, the
perforation into the sinus will be closed however you are
likely to have a acute +/- chronic sinusitis (a chronic sinusitis
is more likely if root debris has gone into the sinus).  There
is a chance, on blowing your nose post-op, that you will get
bleeding from the nose or sinus.  This is treated with
antibiotics, painkillers & decongestants.

Surgical Emphysema.  Very rarely, air can enter the skin
around the apicectomy operation site and become trapped.  
This can lead to swelling, especially around the eyes or
over the cheeks.  This can be quite disconcerting however it
slowly subsides and there is nothing really to worry about.

General Surgical Warnings

Pain.  As it is a surgical procedure, there will be soreness
after the tooth removal.  This can last for several days.  
Painkillers such as ibuprofen, paracetamol, Solpadeine or
Nurofen Plus are very effective.  Obviously, the painkiller
you use is dependent on your medical history & the ease
with which the tooth was removed.

Swelling.  There will be swelling afterwards.  This can last
up to a week.  Use of an icepack or a bag of frozen peas
pressed against the cheek adjacent to the tooth removed
will help to decrease the swelling.  Avoidance in the first
few hours post-op, of alcohol, exercise or hot foods/drinks
will decrease the degree of swelling that will develop.

Bruising.  Some people are prone to bruise.  Older people,
people on
aspirin or steroids will also bruise that much
more easily.  The bruising can look quite severe; this will
eventually disappear but can take several weeks (in the
worst cases).

Bleeding into Cheeks.  Swelling that does not resolve within
a few days may be due to bleeding into the cheek.  The
cheek swelling will feel quite firm.  Coupled with this, there
may be limitation to mouth opening and bruising.  Both the
swelling, bruising and mouth opening will resolve with time.

Stitches.  The operation site will often be closed with
stitches.  These dissolve and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.  Often the chewing muscles and
the jaw joints are sore after the procedure so that mouth
opening can be limited for the next few days.  If you are
unlucky enough to develop an infection in operation site
afterwards, this can make the limited mouth opening worse
and last for longer.

Post-op Infection.  You may develop an infection in the
operation site after the procedure.  This tends to occur 2 –
4 days later and is characterised by a deep-seated
throbbing pain, bad breath and an unpleasant taste in the
mouth.  This infection is more likely to occur if you are a
smoker or are on the contraceptive pill or on drugs such as
steroids.

If antibiotics are given, they are likely to react with alcohol ±
the
Contraceptive Pill (that is, the ‘Pill’ will not be providing
protection).

Failure of Anæsthesia.  In rare cases, the tooth can be
difficult to ‘numb up’.  This can be due to a number of
reasons.  The more common ones include inflammation and
/ or infection associated with the tooth, anatomical
differences & apprehension.
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Last Updated 23rd June 2010