Endodontist Questions Apicoectomy

How successful is an apicoectomy?

I have been advised to undergo apicoectomy to save my tooth. How successful are these treatments? Should I instead consider getting an implant?

10 Answers

Success with apicoectomies depends upon case selection and skill of the clinician. In the right hands the prognosis could be as high as 90%. An implant is almost always another option. If you already have a good restoration in place with no pocketing or bone loss and no suspicion of a fracture or crack, an apicoectomy with proper retrofilling in my opinion is the best option.
Apicoectomy is a highly successful procedure if the tooth has sufficient length and sufficient room to place a good retrofilling. The prognosis is best if there is a definitive deficiency that can be corrected and the tooth is not fractured.
Apicoectomy has a good prognosis. The reason is that at the end of a root of a tooth the anatomy is very complex with lots of little mini canals and hiding spaces for bacteria. If a root canal treatment and maybe even a re-root canal treatment (called retreatment) do not work an apicoectomy may be the answer to save your tooth. The simple description is that the tip of the root (with all of its complexities) is removed and a little filling is placed in the end of the root. This removes all of the bacteria in the hiding places that are not accessible from regular (non-surgical) root canal treatment allowing the tissues and bone around the remaining root structure to heal right up!
There are many factors that come into consideration in the success of any procedure. What about a re-treatment? Is that an option? Presence of infection, location and size of lesion, length of root, and symptoms are some factors which can affect the long-term prognosis of an apicoectomy. Another option is extraction and implant. Ultimately, the decision is up to you.
You can do apicoectomy to save the Tooth, I advise that first before implant
This is tricky question. The biggest factor in it's success is whether the tooth is is entirely reinfected, or if it is suspected that a small portion of the tooth, just the root tip, is infected. Most root canals actually fail because the entire tooth is reinfected. These are usually the older root canals. If it is a root canal is just done with in a year or two, and it has a well sealed restoration, failure might be do more something is left in the root--a secondary canal that instruments can't get, or the dentist could not get to the end of the canal. 30-40% of my business is "failing root canals." 99% of the time I retreat the tooth as a first line of defense. This will typically work ninety some odd percent of the time. I consider Apicoectomy surgeries as a last ditch efforts to save the tooth. I usually do them after a retreat does not work, or it is new rct that I trust who did it. Implants are great alternatives if all else fails.
The success rate depends on a lot of factors: patient health, oral hygiene, tooth position, reasons for failure, integrity of the root canal and restoration
It's hard to give numbers for the success of treatment, it could be 90% successful, but if it fails for you, it's 100% failure for you. But if the case selection is good and done by a good surgeon, then it's a good conservative option.
More information regarding the specific tooth in question is needed in order to give an accurate estimate of the success rate. Basically, the better the condition of the tooth and it's surrounding bone and soft tissue, the better the prognosis. In other words, if there remaining tooth structure is compromised, or if the gums and/or bone around the tooth are not healthy, an apicoectomy may not be enough to solve the problem. However, if there is plenty of healthy tooth structure remaining and the periodontal support for the tooth is good, an apicoectomy should have a good prognosis. An implant is an alternative to saving your natural tooth, and is sometimes a good and the better option. However, generally speaking, it is better to try and save the natural tooth if at all possible, so the implant should really be a last resort when the natural tooth is not salvageable.
Apicoectomy is my 2nd choice of treatment. 1st choice is Re-treatment of the root canal. Last choice would be an implant. Endodontists are dentists who specialize in treating root canals and other pulpal problems. An endodontist should always be consulted if root canal therapy is failing or if you are told "it can't be treated," "too infected," "too complicated," "it
won't work," etc. In my own practice, about 25% of the patients have come in because the root canals failed the first time when done by their general dentist. Endodontists offer a higher success rate. Endodontists have surgical microscopes and specialized training that most general dentists do not have. Please understand that general dentists treat approximately 90% of the root canals in the USA. Endodontists get the tougher ones. Endodontists can have failed root canals, but so can implants (they have the same success rates). If the root canal failed because of fracture, then extraction and implant would be advisable. Endodontists can usually spot fractures with the microscope and thus recommend extraction before you go through the whole process of root canal therapy, post and crown and then problem from the missed fracture. Apicoectomy has about 90% success on an
uninfected canal, and 50% success on an infected canal. Re-treatment of the root canal offers about a 95% success rate. I feel it is always better to clean out the infection that is in the root canal rather than seal it into the root canal.