When the tooth nerve dies, either by trauma, decay or other reason, an infection is generated inside the tooth; this infection travels through the root canal and surrounding structures.
At this moment, the patient may experience a severe pain or sporadically present a small fistula in the gum.
In these cases a root canal therapy needs to be performed, to eliminate the infection and to gradually remove all processes that exist in the bone surrounding the tooth root.
In most cases by performing the root canal therapy the problem is solved. However, there are certain cases where the infection persists. If this happens, there are two solutions. One is to re-do the root canal and see if the infection goes away; the second option is to perform an apicoectomy.
The apicoectomy involves a surgical procedure in which the objective is to eliminate all infectious process found in bone. In order to reach this area, a window is made in the gum at the root of the tooth. In most cases bone graft is needed in order to cover the osseous defect caused by the infection.
The root tip is later sealed to avoid the infectious process to occur again. The apicoectomy allows keeping teeth in the mouth without having to turn to an extraction, which was the only solution available in the past.