Periapical Surgery (Apicoectomy) Definition: Periapical surgery, also known as **apicoectomy**, is a minor surgical procedure performed to remove infection or inflammation in the tissues surrounding the apex (tip) of a tooth root. It is often done when conventional root canal treatment has failed or is not feasible. Indications: * Persistent periapical infection or lesion (granuloma or cyst) after root canal treatment * Presence of root fracture or perforation not accessible through the canal * Anatomical difficulties preventing proper endodontic retreatment * Obstructed root canals (e.g., by calcification, posts) * Endodontic failure with periapical pathology despite proper root filling * Periapical cyst or chronic abscess * Root resorption (external or internal) Contraindications: * Poor oral hygiene or patient non-compliance * Unrestorable or non-functional tooth * Inadequate periodontal support * Proximity to vital anatomical structures (e.g., mental foramen, maxillary sinus) * Severe systemic health issues contraindicating surgery Procedure Steps: 1. Local Anesthesia: Area is anesthetized with local anesthetic (e.g., lidocaine with epinephrine). 2. Incision and Flap Reflection: A surgical flap is created to expose the underlying bone and root tip. 3. Bone Removal: A small window is made in the bone to access the root apex and surrounding lesion. 4. Curettage: Infected tissue or cyst is removed. 5. Root-end Resection: Typically 3 mm of the root apex is removed to eliminate lateral canals and infected dentin. 6. Retrograde Preparation: A small cavity is made at the root end using ultrasonic tips. 7. Retrograde Filling: The cavity is filled with biocompatible material (e.g., MTA, IRM, Biodentine). 8. Closure: The flap is repositioned and sutured. Hemostasis is achieved. Postoperative Care: * Pain and swelling are common; usually controlled with analgesics and ice packs. * Antibiotics may be prescribed if there is a risk of infection. * Soft diet, good oral hygiene, and avoiding the surgical area are advised. * Sutures are typically removed after 5–7 days. * Follow-up X-rays assess healing over time. Complications: * Swelling, bleeding, or bruising * Postoperative pain * Infection * Nerve damage (especially in lower molars near the inferior alveolar nerve) * Sinus perforation (in upper posterior teeth) * Failure to heal or recurrence of lesion Success Rate: The success of periapical surgery depends on: * Quality of root canal treatment * Presence and type of periapical pathology * Surgical technique * Patient’s systemic health