Apiocoectomy on tooth with calcified root


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Nov 13, 2022
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Recently visited my dentist who told me I needed either root canal treatment or alternatively extraction due to the presence of an abscess on my gum. I had very minor pain but thought I should get it checked out. I really do not want to have the tooth extracted so went with the RCT. Anyway dentist drilled a bit of the tooth but was unsuccessful in treating it due to one badly calcified root (other two are okay). She said I would have to have an extraction. She never mentioned the option of an Apiocoectomy and as far as I know they don’t do it at that clinic. Anyone know why Apiocoectomy might not be an option? I’m fairly desperate to keep the tooth and as I said I have no pain with it right now.
 
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Dr M

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Good day

Usually an apicoectomy goes hand in hand with a completed root canal treatment. If an apicoectomy is done on a root that has not had a completed root canal, there is a chance that the infection can just recur after a few weeks or months. That being said, I have had cases where one of the canals on the tooth is completely sclerosed or calcified. I informed the patient and then completed the root canal treatment on the other roots. The tooth did not become painful or had any form of infection, going on 3 years now. Your dentist can either refer you to an endodontist. They are specialists and better equipped to treat calcified canals. Alternatively, he can complete the treatment on the canals he can treat. I would consider an extraction as a last resort.
 

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Thanks for your response. The person I saw was an endodentist. I’m a little confused as to why root canal treatment is required first? I understood that Apiocoectomy is proposed where a root canal has failed, if so then treatment of some/all canals is unsuccessful . How is that different from an endodentist not being able to treat the canal at all due to calcification? I don’t see the benefit in an unsuccessful root canal over a situation where the endodentist hasn’t been able to access the canal.
 

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Dr M

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To explain it in better terms-an apicoectomy is usually done where the root end portion or apical portion of a tooth is sectioned off. If you do this on a tooth which is still alive or vital, it then results in contaminants entering the canal system, leading to pulpitis and eventually pulp death and abscess formation. When a root canal has been performed, the vital nerve tissue and blood vessels have been removed and the canal sealed, so such a surgical procedure carries less risk of causing infection.
Your endodontist might have suggested doing an apicoectomy on the tooth, since the calcification could mean that there is no vital nerve tissue or blood vessels present. The canal is literally closed off completely. With the procedure, she would then hope to clean out the infected tissue around the root tip, in the bone, in order to facilitate healing.
There is still a risk that even with a apicoectomy, the tooth can become infected again and then the tooth will need to be taken out anyways.
 

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