Endodontic surgery is an additional type of endodontic treatment that can preserve your tooth. Surgery may be necessary in a variety of situations, though it is less common than a primary root canal or endodontic retreatment.
More often than not, a tooth that has undergone root canal treatment can last for the rest of your life and you won’t need any further endodontic work. However, due to the complex nature of dental anatomy and each patient’s personal physiology, there are a few cases in which a tooth will either fail to heal as anticipated, or become re-infected. Even after a successful endodontic treatment or retreatment, there are some cases in which a tooth may become painful after several years. If this occurs, endodontic surgery can be a possible solution to save your tooth.
There are times in which a tooth is too calcified for traditional endodontic treatment. What this means is that the tooth lays down calcium deposits to block the root canal, and dental and endodontic instruments are unable to pass through the calcified areas. If the Endodontist cannot reach the end of the root, a surgery can be performed in order to clean and seal the remainder of the root canal.
Surgery can also be used as a diagnostic tool if you have persistent pain or symptoms after a root canal, but no problems are visible on a CBCT or X-ray. In these cases, a surgical approach allows the Endodontist to visually examine the root for fractures or other problems.
Surgery may also be performed to treat damaged root surfaces, clean or debride surrounding bone, or take a biopsy of infected or irritated tissue.
Apicoectomy (Root-End Resection)
The most common type of endodontic surgery is called an apicoectomy. This is also known as a root-end resection. If there is inflammation or infection in the bone around a tooth that fails to heal after an expected amount of time, even after successful endodontic treatment, it may need to be removed. The Endodontist will remove the infection and seal the root from the tip, preventing future infection from recurring.
If you undergo this procedure, you will first be thoroughly anesthetized. Then the Endodontist will open the gum tissue right near the tooth in order to see the underlying bone and root surface. The infection and inflammation will be removed. Oftentimes it is biopsied in order for us to know exactly what the problem was. Usually the infected tissue is attached to the tip of the root, so this is also removed. A small filling is placed in the root to seal the end of the root canal, and several small sutures are placed in order for the gums to heal properly. After a few days, these are removed. Over a period of months, the bone will heal around the tooth back to its normal strength.
Other types of Endodontic Surgery
There are several other types of surgery performed in Endodontics, though they are significantly less common. They include: intentional replantation, root hemi-section, repairing an injured root, or even removing one or more roots, but not the tooth. Dr. Newman will discuss all of these procedures in detail with you, if she feels they are a good option for your specific tooth.
Endodontic Surgery Alternatives
Most of the time, the only alternative to endodontic surgery is to remove your tooth. Once a tooth is extracted, it is recommended it be replaced, either by an implant, a bridge, or a removable device. If the tooth is not replaced, it can cause issues with biting, chewing, smiling, speaking, and can cause other teeth to shift. No matter how effective any of these replacement teeth are, nothing compares to your own natural tooth.
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