When a root canal filling develops a granuloma, cyst, or some other infected area at the end of the root, dentists will sometimes endeavor to save the tooth by performing an operation called apicoectomy. The area of infection seen on x-ray pictures is actually a hole in the bone of the jaw eaten away by bacteria and toxins. It contains pus, bacteria and infected tissue.

The apicoectomy surgery is done using a local anesthetic. An incision is made in the gum and the dentist invades the infected area and curettes away the diseased tissue.

In order to be able to remove all infected tissue surrounding a tooth's root end, it is sometimes necessary to also remove a portion of the tooth's root end (apex). This is done with a surgical dental burr or drill. The term apicoectomy was adopted because the end tip of the root is so often removed during this procedure.

Two or three stitches are used to close the wound. These areas experience some swelling for two or three days but generally heal with very little discomfort. Usually new bone immediately begins to grow and fill in the jaw at the end of the root, and after six to 12 months one can no longer distinguish the location of the infection sight. In other words, the area's appearance is now normal.

At times when cysts or other large areas of infection are found, dentists will elect to do the root canal treatment and apicoectomy at the same sitting. Generally I preferred doing both procedures simultaneously because it was much easier to clean out the root canal that way. In addition, we could spray a disinfectant through the root canal and vacuum the debris and infected material out from the root-end surgical area.

It was also easier to get a good dense root canal filling as any overpacking could easily be removed.

In my practice I did a fair number of these apicoectomy surgeries and I cannot recall any which did not show full healing at the end of the root of the tooth, usually within the period of one year. We were not universally successful with teeth treated nonsurgically.

A couple of case history reports from my files will allow you to see how well infections responded to the apicoectomy procedure.

The first is of a woman who came home from a trip to Mexico with severe diarrhea and intestinal involvement. When a leading Beverly Hills gastroenterologist was unable to cure her intestinal infection, the patient, knowing I was doing nutritional counseling, sought my opinion.

Oral examination didn't indicate any obvious pathologic conditions or tooth decay, but there were many fillings present. Full mouth x-ray examination disclosed large abscesses from accessory canals on both of her upper lateral incisors (the teeth next to the two front teeth).