Endodontic Surgery

Endodontic Surgery (Apicoectomy):

Root canal therapy is a very successful procedure. Over 90% of root canal treated teeth succeed. However, in a small number of cases root canal treatment alone cannot save the tooth. In such a case endodontic surgery, or apicoectomy, may be recommended.

Understanding the need for Endodontic Surgery or Apicoectomy:

• Endodontic surgery can help save your tooth in a variety of ways:
• Detect and treat small fractures at the end of a root.  These root fractures are usually undetectable on an x-ray, but these patients have continued symptoms after root canal therapy.  During endodontic surgery the fractured tip of the root is removed, thus allowing healing to occur.
• Addresses extra canals that cannot be treated nonsurgically.  Even with the added magnification of the dental microscope, some canals cannot be detected during root canal therapy.  The exit of these canals at the end of the root can be addressed and sealed during endodontic surgery.
• Addresses persistent infections in the jawbone related to the recently treated tooth.  Many root canal treated teeth have infections of the bone as well as the tooth.  A very small percentage of these infections won’t heal unless removed from the bone surgically during an apicoectomy.
• Addresses calcified canals that harbor infection but can’t be cleaned by root canal therapy.  Sometimes calcium deposits make a canal too narrow for cleaning instruments to reach the end of the root.  This may allow infection to go untouched and therefore, persist.  Endodontic surgery allows us to seal these canals from the end of the root.

Understanding the Procedure (Apicoectomy):

• In  this procedure, a small incision is made near the tooth to allow access to the infected bone around the tip of the root.  The infected bone and tissues are removed and the area is cleaned with our microsurgical instruments.  The tip of the root is also removed and a small filling is placed to seal the end of the root canal.  A few stitches are placed in the gums to help the gingival tissues heal properly.  Over a period of months, the bone will heal around the end of the
  root.

Will the procedure hurt?

The procedure itself will not hurt as local anesthetics are used to keep you comfortable during the procedure.  After treatment, you may experience some discomfort or slight swelling for a few days.  This is normal for any surgical procedure while the gums heal from the incision.  The appropriate pain medication will be prescribed to you to alleviate this pain during this time period.  If you have questions after your procedure, or if you have pain that does not respond to the medication, please call our office immediately.

Are there any potential problems After treatment?

• For lower, posterior (back) teeth, there is a slight possibility that nerve injury can occur during endodontic surgery.  We are trained to assess this possibility prior to treatment and will advise you accordingly.  The root tips of these teeth may be near a nerve that supplies feeling to the lip, chin and gums.  Rarely, this nerve can become irritated during treatment. In these cases, when the local anesthesia wears off, you may experience tingling, altered sensation or, in rare cases a complete lack of feeling in the affected tissues. Should this occur, it is usually temporary and will resolve over a period of days, weeks or months.  In very rare cases, these changes can be permanent and/or painful.

• The upper teeth are situated near your sinuses, and root canal surgery can result in a communication between your mouth and the adjacent sinus. Should this complication occur, it will usually heal spontaneously.  We will give you special instructions if this is apparent at the time of surgery. We will usually prescribe antibiotics and we prefer that you don’t blow your nose for two to three days after surgery. If you have to sneeze, you should sneeze with an open mouth into a tissue. You should not create any pressure in the sinus area. If you sense a complication after surgery, please contact us.

Post-operative infections occasionally occur. This usually requires just an office visit and examination. Many times placing you on an antibiotic for one week will take care of the infection.  Occasionally, other follow-up procedures will be needed.