Endodontic Surgery

It’s possible that a nonsurgical root canal procedure won’t be enough to save your tooth and that your endodontist will recommend surgery. Endodontic surgery can be used to locate small fractures or hidden canals previously undetected on X-rays during the initial treatment. Surgery may also be needed to remove calcium deposits in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth.

There’s no need to worry about surgery if your endodontist prescribes this additional measure. Advanced technologies like digital imaging and operating microscopes allow these procedures to be performed quickly, comfortably and successfully.

There are many surgical procedures that can be performed to save a tooth. The most common are called an apicoectomy, or root-end resection, which may be needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.

Your endodontist performs this microsurgical procedure first making you comfortable by applying local anesthesia before opening the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed to seal the end of the root canal and a few stitches or sutures are placed to help the tissue heal. In the next few months, the bone will heal around the end of the root. Most patients return to their normal activities the next day. Postsurgical discomfort is generally mild.

How does a root become infected?

As stated above, apical surgery is a procedure used to remove an infection that sometimes attacks the tips of roots. This infection usually begins when bacteria colonize the surrounding bone and spread to the outside of the root. This mat of bacteria is referred to as a biofilm. When the infection reaches the tip of the root, apical surgery is sometimes required to remove the infection. While apical surgery is relatively uncommon with advances in non-surgical treatment, it is still effective in some cases.

Who is a candidate for apical surgery?

Apical surgery is usually reserved for cases that have failed normal root canal treatment. A root canal is the standard treatment used to treat infections around and inside of roots but no procedure is perfect. When a root canal fails to remove an infection, apical surgery is the next option. There are numerous reasons that a separate procedure might fail, including resistant bacteria in the biofilm, another source of infection causing a reinfection, or chronic infection leading to a damaged root that needs removal. With numerous reasons impacting the way infected roots are treated, it is necessary to have a second option in mind. Apical surgery represents this option.

Does apical surgery hurt?

It is common for every surgical procedure to come with some mild discomfort. With this in mind, every patient has various degrees of pain tolerance. When apical surgery is correctly managed, the vast majority of patients handle the procedure without incident. There are numerous options for pain management during the procedure. After the procedure, postoperative management of pain is important. In this situation, there are also multiple options to tailor every pain management regiment to the needs of the patient. Anyone with reservations about the procedure because of the potential for pain should discuss their concerns with a medical professional.

Apical surgery is a procedure used to remove infections from the tips of roots. In most cases, it is used as a backup to a root canal treatment. It is common for patients to have concerns prior to undergoing a surgical procedure. It is important that every patient concern is addressed because every surgical procedure has its risks and benefits. Patients should talk to a qualified medical professional to have their concerns addressed prior to apical surgery.