An apisectomy is a surgical procedure that places a filling in the end of the root and removes any infected tissue from around the tip. It's aim is to contain any bacteria that may be remaining totally within the canal system.
This procedure would only be attempted after a traditional root canal has failed and because of the difficulty in accessing the tips of the roots it is generally only done on the anterior (front) teeth and by a specialist endodontist.[picture]
Apisectomies performed on single rooted teeth have a success rate around 90%, the success rate this for teeth with multiple roots is much lower.
It may be performed in the following circumstances:
Root perforation- where during tooth preparation instruments have pierced the side of the root.
Persistent inflammation and infection remains due to a cyst.
The tip of the root has been fractured due to trauma and has become infected.
Where a post crown is in place and the tooth is problematic- removing posts is very difficult and can often lead to fracture of the root and the tooth being lost. An apisectomy leaves it undisturbed.
Fractured instruments in the canal that cannot be filled around adequately and appropriately.
Difficulty in performing the conventional root treatment due to a closed or very curved canal.
A flap is raised, and a bony window cut so the surgeon can see the tip of the root. All infected tissue around the tip of the root is then removed, the area cleaned and a filling known as a' retrograde filling' is placed to seal the end of the root, before stitches are placed to replace the gum in its original position. The filling material is commonly amalgam or MDA.