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
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
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
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
infections after endodontic treatments are present
- biopsy is
- 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.