Let’s begin by explaining what these procedures are and what the difference between the two is. Root Amputation is the surgical removal of one root of a multi-rooted tooth, usually upper molars because they have three roots. Apicoectomy is the removal of the tip of the root, the apex of the root, of any tooth.
Why might you need one of these procedures done? After you’ve had a tooth that has received root canal treatment, there can sometimes be problems that a re-treatment cannot fix, and if left untreated could lead to the loss of the tooth.
Root Amputation is generally performed in order to eliminate infection and/or prevent further loss of bone in an area where infection or tooth fracture has caused its loss. A tooth that is a good candidate for root amputation is one where one root of a multi-rooted and root canal treated tooth has imbedded bacteria in the root, severe bone loss in a concentrated area due to infection or fracture, or decay in a concentrated area but the rest of the roots have sufficient bone to support the tooth. As long as the problem is only effecting the one root, and the remaining tooth structure is healthy and stable, a root amputation can be performed to save the tooth. If left untreated, the infection or decay can spread to the surrounding area resulting in bone loss which may jeopardizes the stability not only of the tooth being affected, but the surrounding teeth as well. Eventually the whole tooth will be compromised and will need to be extracted, removing one root can help save the tooth and prevent you from needing to pull it and replace it with either a partial, a bridge, or an implant.
Apicoectomy is performed usually after a root canal treatment if there is incomplete resolution of infection at the apical portion. The majority of problems in previously root canaled teeth are caused by problems near the tip of the root, or the apex. Apicos are performed when a re-treatment will not be effective. Indications for apicoectomy include: infection after root canal treatment or re-treatment, inability to clean root canal blocked by a broken file that cannot be removed, a fracture or crack on the apical portion of a tooth root, curved root canal that prevents endodontic files from reaching the apex of the root, or calcification in the tooth that prevents endodontic files from reaching the apex. An apicoectomy is often the last resort to save the tooth before extraction.