Endodontic Surgery/Apicoectomy

There have been many advances in endodontic surgery in recent years. Ultrasonic handpieces with microsurgical retrotips have replaced surgical carbide burs which allow a smaller and more accurate preparation in the long axis of the root. MTA and EBA cements have replaced silver amalgam as a retrofill material which offer a better seal with no tissue staining.
The use of a surgical operating microscope offers an increased view of canal microanatomy to reveal extra canals and fins between canals which previously would have gone undetected.

FAQ’s About Endodontic Surgery

A recommendation for endodontic surgery is often followed by many questions.

Why would I need endodontic surgery?

Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may fail to heal. The tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.

Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows us to examine the root of your tooth, find the problem, and provide treatment.

Sometimes calcium deposits make a canal too narrow for the cleaning and shaping instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification” we may perform endodontic surgery to clean and seal the remainder of the canal.

Surgery may also be performed to treat damaged root surfaces or surrounding bone.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure we may have to perform an apicoectomy.

What is an apicoectomy?

In this procedure, we open 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 is placed to seal the end of the root canal, and stitches or sutures are placed in the gum to help the tissue heal properly.

Are there other types of endodontic surgery?

Other surgeries we can perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. We will be happy to discuss the specific type of surgery your tooth requires. In very complex cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket. These procedures are designed to help you save your tooth.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling afterwards while the incision heals. This is normal for any surgical procedure. We will recommend appropriate pain medication to alleviate your discomfort and will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call us immediately.

Can I drive myself home?

Often you can, but you should ask us before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. We will be happy to discuss your expected recovery time with you.

Does insurance cover endodontic surgery?

Each insurance plan is different. Our office will help you check with your employer or insurance company prior to treatment.

How do I know the surgery will be successful?

We would only suggest endodontic surgery if we believe it is the best option for you. Of course, there are no guarantees with any surgical procedure. We will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option for maintaining your oral health.