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  Apicectomy - Root End Resection  
 

The surgical removal of the root tip and the attached soft infected tissues of an abscessed tooth are defined by the American Association of Edodontists as Apicectomy. This root tip is also called the apical portion of the root. Apicectomy is a minor surgical procedure.

This minor surgical procedure is done and indicated if retreatment has failed or cannot be done, such as a root canal treatment, and also when the tooth has to be retained rather than extracted.

A client’s case is analyzed and evaluated by a health professional through clinical, radiographic, and histological observations and tests. If it is passed the criteria, the retreatment is preferable to apicectomy.

A survey was done of apicectomy cases performed in the 1930s to the 1960s. The survey revealed a success rate ranging from 3% to 99%, with an average success rate of 82.5%. The time duration for a follow up varied from 9 months to 60 months. The evaluation criteria used were not uniform.

Another separate survey of 797 apicectomy cases revealed a success rate of 64%. But the best results of the minor surgical procedure were when a root filling and apicectomy were done at the same visit, and also when the periapical lesion was less than 5mm in diameter. This survey and its results confirmed the findings of a recent study.

For 15 years, a follow up of 1000 cases of apicectomy showed that most healing took place in the first year after the surgery. There were few cases shifted to other healing groups after 4 years of observation. In these 4 years, the complete healing and unsuccessful groups had increased. The complete and uncertain groups on the hand, lessened. The findings of this study were again closely related with the previous studies.

When an unsuccessful root canal treatment was corrected by an apicectomy, root end filling was considered as an appropriate alternative procedure. Root end filling is required for it provides a seal, or it improves the seal of an existing root canal filling.

The retrofilled roots have a failure rate of 27%, compared to 3.6% in cases filled at the surgical appointment by the orthograde procedure. Root end fillings should be done routinely at apicectomy. This should be done unless the orthograde endodontic treatment has been performed in conjunction with apicectomy.

A retrospective studies evaluating apicectomy of the posterior teeth was made on 32 cases of apicectomy. The apicectomy was done due to the presence of cysts, chronic apical infection, or a failed endodontics and root resorptions. There has been a 62% success rate basing from the radiographic and clinical criteria.

There is another study of 314 maxillary canines, premolars and molars which had undergone apicectomy. The results were a success in 54% of the cases, a failure of 21% cases, and uncertain outcomes in 25% cases. Maxillary first molars have 44%, which have the lowest success rate. There were three studies that involve 160 molars. It was reported to have a success rate of 70%.

Another study of 136 molars that undergo apicectomy reported a success rate of only 44%. But the radiographic evaluation was more stringent, while the clinical evaluation was done by less severe criteria.

A much more rigorous criterion was used in a recent study. The evaluation was done of apicectomy on 102 teeth, where 62% were premolars and molars that had previously undergone non-surgical treatment. A success rate of 91% was shown in radiographic evaluation criteria and clinical evaluation of signs and symptoms of disease or loss of function. The high success rate in this study may be due to well-defined case selection where the more severe cases were excluded.

Apicectomy is indicated and performed on the basis of specific criteria. There cases should or where:

  • conservative endodontic treatment is not able to be done due to various root canal defects
  • there is a presence of obstruction in the root canal
  • medical reasons and time factor is essential
  • persistent infections after endodontic treatments are present
  • biopsy is needed
  • the resected root face needs to be evaluated for any additional canals or fracture

There have been reports of adjunct therapy to the apicectomy procedure. These adjunct therapies include the use of a membrane to enhance or induce bone healing after apicectomy. The ultimate goal is to be able to allow bone formation rather than fibrous connective tissues to grow.

A retrospective study of 129 cases of repeat apicectomy showed a success rate of 35%. The clients were to have a one-year follow up. In the 25% cases, the repeat apicectomy was done within the year. This is because of clinical reasons rather than radiographic reasons. The canal is to be sealed apically to ensure success of the procedure. But the success rate in the repeat procedure is reportedly lower than the success rate in the first apicectomy.

Today, there has been a decline on apicectomy. Apicectomies by general practitioners have declined over the past years in some countries. The increased skill levels of dentists as well as increased availability of specialists are some of the reasons of this decline.

 
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