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Endodontic Surgery Explained

Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and surgery may be recommended. Read on to learn why you might need endodontic surgery and view a step-by-step explanation of the most common surgical procedure, an apicectomy.

Why would I need endodontic surgery?
  • Surgery can help save your tooth in a variety of situations.
  • Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows us to examine the entire root of your tooth, find the problem, and provide treatment.
  • Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical(conventional) root canal treatment to reach the end of the root. If your tooth has this “calcification,” endodontic surgery may be performed to clean and seal the remainder of the canal.
  • Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
  • Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, an apicectomy may have to be performed.

Apicectomy

What is an apicectomy?

In this procedure, the gum tissue near the tooth is opened up to see the underlying bone and to remove anyinflamed or infected tissue. The very end of the root is also removed.

Apicectomy

A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva(gum) to help the tissue heal properly.

Apicectomy

Over a period of months, the bone heals around the end of the root.

Apicectomy

Are there other types of endodontic surgery?

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. These procedures are designed to help you save your tooth.

Will the procedure hurt?

Local anaesthetics make the procedure comfortable. It is most likely that you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Appropriate pain medication to alleviate your discomfort will be recommended and specific post-treatment advicewill be provided. If you have questions after your procedure, or if you have pain that does not respond to medication, we would ask you to contact us.

Can I drive myself home?

Often you can, but this can be discussed before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. We will be happy to discuss your expected recovery time with you.

How do I know the surgery will be successful?

Your dentist or endodontist is suggesting endodontic surgery because he or she believesit is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. The chances of success for the proposed treatment will be discussed so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth may then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. As these alternatives canrequire more extensive surgery or dental procedures on adjacent healthy teeth, endodontic surgery can often be/is usually the most biologic and cost-effective option for maintaining a healthy, functioning natural tooth.

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