Patient Guide for an Apicoectomy (Root-End Surgery)

Q: Why do I need this surgery instead of another root canal?

An apicoectomy is recommended when a traditional root canal retreatment is not possible or has already failed. Think of it as a “last ditch effort” to save an important tooth. Common reasons include: A large post inside the tooth that is too risky to remove. Severe calcification or ledges that are blocking us from reaching the root tip from inside the tooth. A persistent infection that did not resolve after a previous, well-done root canal. This surgical approach allows us to clean and seal the root tip directly from the outside when we cannot get to it from the inside.`

Q: What are the chances this will work?

The success rate for an apicoectomy is generally high, provided that the problem is confined to the root tip. However, it is a procedure to save a tooth that is already heavily compromised. The biggest risk we can encounter during the surgery is discovering a deep, vertical root fracture. If a fracture is found, the tooth is not salvageable and will need to be extracted. Our commitment is to give you a clear and honest assessment of the tooth’s long-term prognosis once we have all the information.

Q: What is the recovery like compared to a regular root canal?

The recovery is different. A regular root canal has very little post-operative effect on your gums. An apicoectomy is a minor surgical procedure, so you should expect some swelling, bruising, and tenderness in the gum tissue, similar to a surgical extraction. The discomfort is typically well-managed with the prescribed pain medication regimen.

Q: What if this procedure doesn't work?

An apicoectomy is truly the final attempt to save a natural tooth. If the tooth does not heal as expected after this procedure, the only remaining option is to have the tooth extracted and discuss replacement options, such as a bridge or a dental implant.

Surgical Care Instructions

Pain Management

An apicoectomy is a minor surgical procedure, and some post-operative soreness is normal. Managing this is key to a comfortable recovery.

Pain Management: For the first 2-3 days, we recommend a scheduled regimen of 600mg of Ibuprofen with 500mg of Acetaminophen (Tylenol) taken together every 6 hours. This is highly effective at managing inflammation and discomfort.
Timeline: The soreness should gradually improve each day. If your pain worsens significantly after 3 days, please contact our office.

Bleeding Control

Minor oozing of blood from the incision site is normal for the first 24 hours.

Pressure: If you notice active bleeding, apply firm but gentle pressure to the area with a piece of moistened gauze for 30 minutes.
Avoid: Do not spit, use a straw, or smoke. Avoid vigorous rinsing, as this can disturb the healing site.
Pillowcase Pro-Tip: Use an old or dark-colored pillowcase for the first night. A small spot of blood is normal; a saturated pillow is not.

Swelling Management

Swelling and bruising in the surgical area are very common and expected.

Ice Packs (CRITICAL): For the first 24 hours ONLY, apply an ice pack to the outside of your face over the surgical area for 20 minutes on, then 10 minutes off.
Peak Swelling: Swelling will peak on the third day after surgery, after which it will begin to gradually subside. Bruising may appear on your cheek and can change color as it heals.
Elevation: Keep your head elevated with extra pillows when resting or sleeping to help minimize swelling.

Oral Hygiene/Site Care

Protecting the surgical site is the most critical part of your recovery.

DO NOT pull your lip or cheek back to look at the site. This can tear the delicate sutures and delay healing.
DO NOT brush the surgical site directly until the sutures are removed or have dissolved. You can and should brush all other teeth normally.
Rinsing: After 24 hours, you may begin gently rinsing your mouth with the prescribed medicated rinse or a warm salt water solution after meals. Let the water fall out of your mouth; do not spit forcefully.
Sutures: Your stitches may be the kind that dissolve on their own in 5-10 days, or we may need to remove them at your follow-up appointment.

Dietary Recommendations

Stick to a soft, non-chew diet for the first few days. Good options include smoothies (no straw), yogurt, mashed potatoes, and lukewarm soup.
Avoid chewing on the side of your mouth where the surgery was performed.
Do not eat anything hard, crunchy, or spicy that could irritate the surgical site.

Activity Restrictions

Avoid all strenuous physical activity, exercise, or heavy lifting for at least 3-5 days. Increased blood pressure can cause bleeding at the surgical site.