Apicoectomy

Why would you need endodontic surgery (an apicoectomy)?

A root canal is usually all that is needed to save teeth with injured pulp from extraction. Unfortunately, sometimes this non-surgical procedure will not be sufficient enough to heal the tooth, so your endodontist will 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 the surrounding bone may also be treated with this procedure. This is one of the most common surgeries done to save damaged teeth.

What is an Apicoectomy?

This simple surgical procedure starts with an incision made in the gum tissue to expose the bone and surrounding inflamed tissue. Then damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. Over a period of months, the bone will naturally heal itself around the root, restoring full function.

While the incision heals, there may be some slight swelling or discomfort. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.

What is a root canal?

A root canal is one of the most common dental procedures performed, over 14 million are done each year. This treatment can save your natural teeth and prevent the need for dental implants or bridges.

Pulp, which is at the center of your tooth, is a collection of blood vessels that helps to build the surrounding tooth. Trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures can cause infection to the pulp. Infection symptoms can be identified as visible injury or swelling around the tooth, sensitivity to temperature or pain in the tooth and gums.

How is a root canal performed?

The injured pulp is removed and the root canal system is thoroughly cleaned and sealed. Local anesthesia may be needed to eliminate discomfort and the procedure is usually completed in one or more visits depending on the treatment required. In 90% of the cases, success of treatment occurs. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.

What happens after treatment?

A record of your treatment will be sent to your restorative dentist, once your root canal therapy has been completed. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene.

Retreatment

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Sometimes, a tooth that has received treatment may fail to heal or pain may continue to exist. In some cases, the pain may occur months or years after treatment. If so, root canal retreatment may be needed.

Improper healing may be caused by:

• A crown or restoration that was not placed within the appropriate amount of time following the procedure.
• A crown or restoration that did not prevent saliva from contaminating the inside of the tooth.
• Curved or narrow canals that were not treated during the initial treatment.
• Complicated canals that went undetected during the initial treatment.

In some cases, new problems can influence a tooth that was successfully treated:

• New decay can expose a root canal filling material, causing infection.
• A cracked or loose filling or crown can expose the tooth to new infection.

Retreatment includes reopening your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctor will then clean your canals and carefully examine the inside of the tooth. Once cleaned, the doctor will fill and seal the canals and place a temporary filling in the tooth.

Once this is done, you will need to return to your regular dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.

Retreatment cases are more difficult, more time consuming and therefore more costly than initial root canal cases. Once in a while, some insurance companies will not reimburse the patient for retreatment of a previously treated tooth, especially if it has only been a year or two since the original treatment. It is best to either contact your insurance carrier or our office to confirm the available coverage.

Root Amputation

Removal of a fractured root on a multi-rooted tooth.

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