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 of warnings might seem excessive to some
however the legal ruling in the case of
Chester vs Afshar
(2004)
would suggest that it is quite prudent / necessary
to list them.  Others might say that there isn't enough
information but where do you stop?

The following list of warnings regarding
apicectomies is
neither 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.
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Last Updated 26th December 2014
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.
Sub-Cutaneous (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 operation.  
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
operation site 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.