Microscopic Surgery (Apicoectomy)
Surgery can help save your tooth in a variety of situations:
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 not heal or become infected. A 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 and avoid extraction.
Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification,” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
Surgery may also be performed to treat damaged root surfaces and surrounding bone or to remove cysts.
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 cases, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy, or root-tip resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, an apicoectomy may be required.
In this procedure, the endodontist opens 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 in the root to seal the end of the root canal, along with a few sutures to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.