Gingivitis after apicoectomy

If the healed gums start to bleed when brushing teeth after a root tip resection or if they are very sensitive to pressure and painful, this can be a sign of gingivitis. Depending on the duration and intensity of the inflammation, bad breath and pus can occur. As soon as the symptoms of gingivitis become apparent, a dentist should be consulted. The dentist will administer anti-inflammatory drugs to quickly reduce the painful inflammation.

Risks of apicoectomy/possible causes of inflammation

Since this treatment is a surgical procedure, a variety of risk factors can occur during or after the treatment. In the upper jaw, especially in the posterior region, there is a risk of opening the maxillary sinus and allowing bacteria to enter it. This is the case if the patient’s tooth roots are particularly long, sometimes even reaching into the maxillary sinus.

If they become inflamed and are removed, the close proximity to the maxillary sinus is a problem. If an opening occurs, it should be covered plastically to prevent the migration of bacteria from the oral cavity. If bacteria have nevertheless entered the maxillary sinus and caused an inflammation there, the most effective method is therapy with antibiotics after an antibioogram.

The appropriate antibiotic is either applied directly into the maxillary sinus or taken in the form of tablets. In the lower jaw, the danger is rather that important supplying parts, such as nerves or blood vessels, are injured, because these are located in the vicinity of the tooth roots. Loss of sensitivity and taste can be the consequences.

Of course, there can also be wound healing disorders caused by external factors or diseases. This occurs more frequently in people who suffer from a weakened immune system, diabetes mellitus or generally have poorer blood circulation. But also if after the operation no care is taken (e.g. sneezing is avoided because it creates high pressure), oral hygiene is neglected or nicotine is substituted.

If the adjacent teeth have a tight connection to the treated tooth, they too can be damaged during the procedure. Unfortunately, an apicoectomy does not always lead to the desired success, so that renewed inflammation can occur afterwards. It can happen that root tips remain behind and become inflamed.

This is noticeable in that the pain does not subside and remains after the removal of the root apex beyond the normal healing phase. Furthermore, a renewed inflammation can remain unnoticed for a long time (sometimes many years) and only radiate inflammation symptoms at a later stage.Since only the root tips have been removed and the remaining part of the root still has a filling (the previous filling is retained or a new one is made during the procedure), it is possible that bacteria still present in the filled canals can get into the surrounding bone tissue and cause an inflammation of the jaw bone there. What alternatives are there to avoid a root tip resection and the associated risks and centres of inflammation?

In many cases this depends on the individual situation of the patient. In general – in order to avoid a root apex resection – there is the option of extracting the diseased tooth. A root apex resection is primarily performed to preserve the tooth as long as possible, even if it is less stable due to the shortened root.

It can be crowned over or may still be available as a bridge abutment. Extracting the tooth would eliminate many of the possibilities for inflammation, since the triggering bacterial component is completely removed and healing usually only leads to wound healing disorders, and not to an inflammation caused by bacteria that have remained or migrated. However, even with such an operation there is a risk of post-operative complications.

If the inflammation reoccurs, further surgery may be necessary, depending on what the trigger is. The apicoectomy can be performed again, inflamed tissue can be removed or formed abscesses can be cut open. However, if problems still occur or if a new intervention does not seem to make sense, it is still possible that the tooth will be extracted.