When conventional root canal treatments fall short, endodontic surgery can be a critical option to save a tooth that might otherwise be lost. One of the most common procedures in such cases is an apicoectomy, or root-end resection, which targets persistent infections or damage at the root tip. Learn more about it here.
When is Surgery Often Recommended?
Surgery can help save the tooth in a variety of situations :
- For Diagnosis – In the presence of persistent symptoms but no problems appear on the x-ray, the tooth may have a tiny fracture or canal that could not be detected during root canal treatment
- To seal the end of the root – Sometimes, calcium deposits make a canal too narrow for the instruments used in root canal treatment to reach the end of the root.
- To treat non-healing and infected roots
- To treat damaged root surfaces or surrounding bone
The most common endodontic surgery is called apicoectomy or root-end resection. It is performed when inflammation or infection persists in the bony area around the end of the tooth after a root canal treatment. It is a specialised dental procedure performed when traditional root canal treatment fails to eliminate infection or address persistent problems in the root tip area.
This procedure aims to save a natural tooth by removing infected tissue and sealing the root end.
What is Apicoectomy (Root-End Surgery)?
Apicoectomy, also known as root-end resection involves opening the tissue near the tooth and removing the infected or inflamed tissue along with the root tip. After, fillings will be placed in the root end and the tissue may also be sutured to help it heal.
When Do Dentists Recommend Endodontic Surgery?
Root-end surgery (apicoectomy) is recommended in the following scenarios:
- When the root canal-treated tooth does not heal despite adequate treatment and non-surgical retreatment is not advised.
- In conjunction with conventional root canal retreatment to explore cracks or potential fractures on the root.
- To perform biopsies and remove cysts or growths that may be present.
- When there are calcified canals. When calcium deposits block access to the root canals during conventional treatment.
What To Expect During Endodontic Surgery
Root end surgery or apicoectomy does not require much preparation and there’s no reason to fast before the teeth-saving procedure. The general steps typically include:
- Giving you anaesthesia: Local anaesthesia is administered to ensure patient comfort throughout the procedure.
- An incision to open up the tissues: A small incision is made near the infected area is lifted to inspect the underlying bone and tooth root.
- Root tip removal and cleaning: The root tip together with surrounding infected tissues are to be removed under magnification with a microscope.
- Root end filling: A small biocompatible filling is placed to seal the resected root tip and if there is extensive bone loss, a collagen membrane may be placed to aid in healing and bone regeneration ( Guided tissue regeneration )
- Suturing: Stitches are then placed to secure and stabilize the gums to allow for optimal healing.
- X-ray: Regular reviews with X-rays of the tooth done to monitor bony healing.
After endodontic surgery, patients may experience mild discomfort, swelling, or bruising. These symptoms can be managed with pain medication and cold compresses. It’s crucial to follow the dentist’s post-operative instructions carefully to ensure proper healing. This may include avoiding hard-to-chew foods (eg. crunchy, chewy), practicing good oral care (eg. the use of antiseptic mouth rinse), and attending follow-up appointments to check progress and remove stitches.
Key Takeaways
Root-end surgery is recommended when a root canal treated tooth has not healed despite adequate treatment. The procedure involves administering local anaesthesia, making a small incision to access the affected tooth’s root, removing the infected root tip, cleaning the surrounding area, sealing the root end with biocompatible material, and suturing the gum tissue back together. Patients may experience mild discomfort, swelling, or bruising after surgery, but these symptoms can be managed with pain medication and cold compresses.
References:
Endodontic Surgery Explained – American Association of Endodontists, https://www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-surgery/endodontic-surgery-explained/ Accessed October 12, 2024
Endodontic Surgery – Conditions & Treatments | SingHealth, https://www.singhealth.com.sg/patient-care/conditions-treatments/endodontic-surgery Accessed October 12, 2024
Why You Need an Apicoectomy: Procedures and Risks https://www.webmd.com/oral-health/what-to-know-about-an-apicoectomy Accessed October 12, 2024
