Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. However, occasionally, this procedure alone may not be sufficient to heal the tooth and Dr. Citron or Dr. Zargar may recommend surgery.
Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.
Your teeth are held in place by very strong roots that extend into your jawbone. Unlike the front incisors which only have a single root, molars and premolars have several roots. The tip of the root is called the apex. This is where the nerves and blood vessels enter the tooth, and help deliver blood to the crown (the portion of the tooth you see in your mouth).
When there is still some infection present after root canal therapy, or re-infection occurs, you may require an apicoectomy. During an apicoectomy, we remove the apex (or root tip) and seal the root tip to prevent any further infection. If left untreated, infected roots can cause damage to other teeth, spread infection, and cause resorption/damage to the jawbone.
When the tissue surrounding the root of a tooth becomes infected or inflamed, it can be incredibly painful and debilitating. The apicoectomy eliminates the infection and allows the tooth to function normally without having to be extracted.
There are also instances where infections may be completely asymptomatic, so regular exams with your general dentist are important.
Some examples of circumstances when you may require an apicoectomy include:
Before your surgery, your endodontist will typically prescribe an antibiotic or anti-inflammatory medication in order to treat your underlying infection. Then we will take an X-Ray and 3D CT scan to allow the endodontist to properly plan for the apicoectomy.
The procedure will be performed under local anesthesia. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip under a dental operating microscope designed for microsurgery. Thorough inspection of the area will be performed. A root-end filling is placed to prevent reinfection of the root and the gum is sutured.
You will be provided with detailed post-care instructions, and given prescriptions for pain relief and antibiotic therapy as needed for your individual situation. We will schedule a follow up appointment to have the endodontist examine the healing process, and remove the sutures. We will follow up to check on the healing.
The video below discusses and illustrates this procedure.