anyone had an apicoectomy? i need to know the pros and cons about this surgery.?

Question: my #14 tooth (upper left) has been bothering me for many years. i had a root canal several years ago and that helped some. now, however, i am having pain again and my endodontist has referred me to an oral surgeon who has suggested the apico. any words of wisdom?

Answers:
The object of root canal is to seal the end of the tooth. Sometimes, this is just not possible, because the vascular bed (with the nerves) at the end of the tooth doesn't exit as distinctly through one single hole as we wish that it did. There are many smaller side exits with accessory nerves in EVERY tooth. These are usually "taken care of" by conventional treatment. What this really means is that we are lucky enough that the accessories are not big enough to cause any trouble. Sometimes, though, they are and the dentist needs to make a direct approach to seal the tooth from the bottom of the root instead of trying to get at it from the top of the tooth.

If you are having this done, the dentist will make an incision to get to the end of the tooth. He will make a small hole in the bone to expose the tip of the root. He will cut of about a millimeter or so of the end of the tooth and place a small filling directly at the site. He will clean out the abscess/granuloma site while he is in there. The site will be sutured closed and you're done.

Now... I have to tell you that an apico on #14 is difficult. If the root that needs treatment is either the MB or ML (Ask.), access is not too bad. If it is the palatal root, it's all but impossible. Fortunately, the palatal root is usually the easiest to treat by conventional endo and it is the least likely to fail. One concern to discuss would the location of the floor of the sinus. Another consideration might be to remove just the offending root of your tooth. If the tooth is pretty sound periodontally and the offending root is MB or ML, you might do just as well to have the one root removed and some bone grafting material placed in the socket that remains. This might be considered the "ultimate" apicioectomy...

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If it is abcessed, don't even think twice..just get it done. I had a patient that I took care of once that didn't have time to get a tooth pulled and the abcess went to his brain, and now he basically a vegetable. It was very sad.

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