CBCT-Guided Apicoectomy for Patients in West Finchley

An apicoectomy is a minor surgical procedure to save a tooth after a conventional root canal has failed. It involves removing the very tip of the tooth's root (the apex) along with any infected tissue. The key to success is precision. That's where a Cone Beam Computed Tomography (CBCT) scan is so important. Unlike a standard 2D X-ray, a CBCT scan provides a detailed 3D image of your tooth, jawbone, and surrounding nerves. For our team, this isn't optional; it's essential. It allows us to map out the surgery with incredible accuracy before we even begin, identifying the exact location of the infection and avoiding any surprises. This approach significantly increases the procedure's success rate, which is over 90% in most cases.

An apicoectomy is typically recommended when a previous root canal treatment has failed and retreatment isn't a suitable option. You might need this procedure if you have a persistent infection that doesn't resolve, often appearing as a small pimple on the gum or causing a dull ache. It's also the treatment of choice when a cyst has formed at the root tip, or when complex root anatomy, like a curved canal, prevents a standard root canal from being fully effective. For example, a patient from West Finchley recently came to us with a molar that remained painful months after a root canal. The 3D CBCT scan revealed a tiny untreated fourth canal that caused the persistent infection, something a 2D X-ray had missed. The apicoectomy allowed us to resolve the issue directly.

First, you will attend a 60-minute consultation where we take a CBCT scan, which takes less than a minute, to assess your tooth's anatomy and plan the surgery. On the day of the procedure, the area will be fully numbed with local anaesthetic. The procedure is performed using a dental operating microscope for magnification. A small incision is made in the gum to access the root tip. Next, the infected tissue and the last few millimetres of the root are removed. The end of the root canal is then cleaned and sealed with a biocompatible filling. Finally, the gum is stitched back into place. The entire surgical appointment typically lasts between 60 to 90 minutes. Most patients report feeling pressure but no pain during the treatment.

Proper aftercare supports a smooth recovery. For the first 24-48 hours, you can expect some swelling and mild discomfort. Use ice packs on your cheek for 20-minute intervals to manage swelling, and over-the-counter anti-inflammatories like ibuprofen to manage pain. Eat soft foods for a few days and avoid chewing on the treated side. Limit vigorous rinsing or spitting for the first day. Your stitches will either dissolve on their own or be removed at a follow-up appointment about a week later. Red flags requiring a call: Contact our practice during office hours (Mon/Wed/Fri 9-5, Tue/Thu 11-7) if you experience increasing pain after day three, a fever above 38°C, or uncontrolled bleeding. For out-of-hours emergencies, contact NHS 111 or visit your nearest A&E.

While an apicoectomy is highly effective, it helps to know your options. The main alternatives are root canal retreatment or tooth extraction. Root Canal Retreatment: This involves redoing the original root canal. It can be a good option if the initial treatment was compromised, but may not work if the infection is established at the root tip. Extraction: Removing the tooth is a last resort. While it solves the immediate infection, it can lead to bone loss and shifting teeth. Replacing the tooth with a dental implant or bridge is a significant additional cost, often more than the cost of saving the tooth with an apicoectomy. We aim to save natural teeth whenever possible and will help you decide which option truly suits your long-term dental health.

To make an informed choice, whether you visit us or another practice near West Finchley, here are essential questions to ask: 1. Do you use a CBCT scan to plan every apicoectomy? 2. Is the procedure performed with a dental operating microscope? 3. What is your success rate with this specific procedure? 4. What does the quoted cost include? (e.g. scans, follow-ups) 5. What material do you use to seal the root end (MTA is the gold standard)? 6. Who will perform the procedure and what are their qualifications in endodontics? 7. What are the specific risks in my case, based on the 3D scan?