ORTHODONTICS, ORAL SURGERY, ORAL & MAXILLOFACIAL SURGERY Apicectomy Surgical removal of the dental root end may be necessary when orthograde (conventional root canal) treatment had failed and a re-treatment is unsuccessful or is not advised. Orthograde treatment is the treatment of choice in most cases of peri- radicular disease. Apicectomies are not a substitute for poor/inadequate root canal treatment. The PCT will fund surgical endodontics in accordance to following guidelines: Indications for Apicectomies Presence of peri-radicular disease in a root filled (adequate) tooth. If the root filling is poor re-root filling should be attempted if at all possible. If re-root filling is not possible (obliterated canals, post etc.) apicectomies may be considered but prognosis is worse. Biopsy of peri-radicular tissue is required e.g. odontogenic cysts and other pathological conditions Managing root perforations cracks. Patient factors that preclude prolonged dental treatment such as root canal treatment. Contra-indications Medical history y Anatomical factors: root morphology, poor surgical access, risks to adjacent structures (nerve bundles), tooth not restorable, poor periodontal condition. Referral Guidelines to secondary care Upper anterior teeth 3---3 with adequate root fillings or fulfilling the above criteria will be treated. Will not consider multi rooted teeth for apicectomy unless there are exceptional circumstances (e.g. bridge abutment). Will advise to extract. Mandibular teeth 5 to 5 are not good candidates for apicectomy due to the risks to the mandibular nerve, thickness of the bone and poor access. The incisors have relatively short, slim roots making apicectomy less successful. These teeth can be considered for apicectomy but the general advice will be to extract. Always include an adequate radiograph. Referrals without radiographs will not be considered.