What is an Apicectomy?
An apicectomy is a surgical procedure to remove the tip of the root of a tooth buried within your jawbone.
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Will I look different after the surgery?
You will almost certainly look different to some degree; quite how different depends on the extent of your original problem and how much the jaw(s) have had to be moved.
Orthognathic surgery aims to balance the bony framework of the face, so that all the features are in proportion to one another, producing a pleasing facial appearance and teeth that chew better.
The vast majority of patients are delighted with the results, and although there may be some difficult times during the treatment, once it is completed the benefits will often last a lifetime!
Can I eat normally after surgery?
The mouth opens and closes normally, even on the day of surgery, but this opening is limited by the elastic bands, placed between upper and lower teeth, and swelling.
You will be encouraged to eat and drink from the first day, and gradually progress from soft, very mushy or liquid food, to a normal but soft diet over the next few weeks.
Our dietitians will give further advice, and there is a separate dietitian information sheet on managing your diet after jaw surgery, if required.
How long will I be in hospital?
This depends on the individual, but most patients stay in hospital for one or two nights after surgery.
People vary in their speed of recovery, but you should consider taking between two and six weeks off from your usual commitments.
What are the risks of having a general anaesthetic?
This type of treatment is not compulsory or life saving for any patient and, whilst there is a very small risk of not waking up after a general anaesthetic, this must be balanced with how much the tooth/jaw position is a concern to the patient and whether an operation can definitely improve jaw position.
Immediately following a general anaesthetic, you may feel tired, dizzy or weak. You must have someone to collect you and stay with you for the first 24 hours.
During the first 24 hours, you must not drive or operate any motorised vehicle or electrical equipment, sign any legal documents, make any important decisions, or drink any alcohol.
You may feel weak or dizzy at times during your first 7 – 10 days. If this happens, sit down until the feeling passes. You may also have the postoperative “blues”, though this should soon pass.
What are the complications associated with this procedure?
This is usually a very safe procedure, which is carried out regularly in this hospital by specialised and experienced clinical staff.
Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them. Your surgeon and orthodontist will discuss your individual risk rates for your treatment.
The most commonly reported complications are:
Numbness
Your lips, chin and gums may all be numb immediately after your operation. The upper lip recovers relatively quickly, while the lower lip is much more variable and may take six to nine months to get normal feeling back.
In 30% of cases, there may be some permanent loss or alteration of sensation, but the lips look and move normally, and surveys suggest that this rarely bothers patients.
Infection
The small titanium plates and/or screws are usually left in place permanently. In less than 10% of cases, the plates may have to be removed if they should become infected. If this is the case, the plates can be removed during a short day case procedure.
Readjustment of the bite
Occasionally, patients may wake up from their relaxed state (caused by the anaesthetic) and the strong jaw muscles then alter the position of the jaw. Although the bite may be only a few millimetres out of place, a second operation to adjust the bite fixation may be necessary.
Surgical Relapse
With most patients, significant relapse is not a problem. However, in those who are having complicated surgery (movement of 10 mm or more in one jaw, patients previously having had a cleft palate, or those with a particularly unusual bite), relapse can occur, where the muscles, skin, tongue and lips of the face pull the face and teeth towards their original position. If relapse does occur, it is exceptionally rare for this to be significant. However, there is also orthodontic relapse and long-term, age changes which the orthodontist will discuss with you.
Blood loss
Blood loss is usually minimal and a blood transfusion is rarely needed; less than 1% of our patients have needed a blood transfusion.
Limitations of mouth opening
There may be limitations of mouth opening, but this resolves as healing progresses. Symptoms of jaw pain and dysfunction can be made worse by jaw surgery.
Changes to the shape of the nose
An operation on the top jaw may alter the shape of your nose.
Will I be swollen and in pain after my surgery?
The main problems after surgery are numbness and swelling and often some bruising, rather than pain.
Everyone is different, but most patients find the swelling is at its worst at 36 – 72 hours after the surgery, and then gradually goes down over the next fortnight.
To help to reduce the swelling you will be given a Hilotherapy mask that fits closely over your face. The mask is connected to a Hilotherapy machine that pumps cold water around the mask, reducing pain, swelling and bruising.
Your final appearance will initially be masked by the swelling and may take several months to emerge as the shape of your face adjusts.
Pain and discomfort is worse during the first 24 hours, and will be controlled with regular pain killers. You may find it uncomfortable breathing through your nose, especially if you have upper jaw surgery and you may have a sore throat following your anaesthetic.
You may also feel uncomfortable and “sorry for yourself” for the first few days, but this normally settles over time. In our experience, older patients seem to find these symptoms worse and take longer to get over their operation than younger patients.
Planning for surgery
When you are ready for your operation, you will again be seen on a joint orthognathic surgery clinic for your team to discuss with you once more your expectations and proposed surgical movements.
Planning continues with the production of surgical plastic wafers that fit over and between the teeth guiding your surgeon at the time of surgery.
To make these wafers you will need some further moulds of your teeth, facial measurements and, in some cases, a 3D Cone Beam Computed Tomography (CBCT) scan is required.
A CBCT scan is a low-dose x-ray examination, which produces a very precise 3D image of your teeth and bony facial structures.
How long will the treatment take?
In total, the treatment usually takes about two and a half to three years, with the surgery occurring between 18 months and two and a half years after the start of orthodontics.
Please note that missed appointments and any breakage of the braces lengthen the period of orthodontic treatment.
