Swelling after apicoectomy

Apicoectomy is one of the last attempts to save a tooth, but even after the procedure, swelling is not abnormal. Studies have shown that apicoectomy has an 80% chance of success after 5 years. But what are the causes of the symptoms that can appear after the operation and how pronounced can the reaction be? Does this mean that the operation has failed and the tooth is no longer worth preserving, or is apicoectomy a sustainable and good form of therapy that gives the affected tooth a good prognosis?

Causes of swelling after apicoectomy

Swelling after apicoectomy can have various causes. Postoperative wound closure usually always results in swelling of the treated area. This swelling is caused by the fact that in order to reach the root apex, the gum has to be cut open with a scalpel and detached from the bone.

As a result, the tissue layers are traumatized and can swell after suturing, as they heal. This swelling is a small distension that disappears quickly. Therefore, it is part of the healing process and is not a sign of a failed procedure.

If there is a strong swelling that shows signs of spreading, an infection of the wound edges is often the cause. This infection can already be caused by the bacteria in saliva. The bacteria settle on the wound edges and if the immune system is unable to fight them, they trigger local inflammation.

Furthermore, it may be the case that during apicoectomy not all pathogens below the root tip have been removed and complete disinfection fails. Then the original apical periodontitis, the local inflammation below the root tip, forms again and can spread. In addition, a cyst can develop from this, which causes severe discomfort.

Diagnosis of swelling after apicoectomy

The diagnosis of swelling after apicoectomy does not necessarily mean that the tooth has to be removed. If not all bacteria below the root tip have been removed during the resection, the apicoectomy can be repeated to fight the infection. Usually, however, the body is given a certain amount of time to regenerate and there is a chance that the inflammation will subside again.

The administration of antibiotics can also be helpful. In a second operation, the root tip is often closed from below (retrograde) (this is also done in the first operation) to ensure sterility. If this attempt also fails and the swelling does not recede but spreads, the affected tooth can ultimately only be removed to stop the infection. However, tooth removal is the very last resort if no other treatment approach is effective.