What is endodontic surgery (Apicoectomy)?

It’s possible that a nonsurgical root canal procedure won’t be enough to save your tooth and that your endodontist will recommend surgery. Endodontic surgery can be used to locate small fractures or hidden canals previously undetected on X-rays during the initial treatment. Surgery may also be needed to remove calcium deposits in root canals, or to treat damaged root surfaces or the surrounding bone of the tooth.

There’s no need to worry about surgery if your endodontist prescribes this additional measure. Advanced technologies like digital imaging and operating microscopes allow these procedures to be performed quickly, comfortably and successfully.

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There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which may be needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.

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Your endodontist performs this micro surgical procedure first making you comfortable by applying local anesthesia before opening 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 to seal the end of the root canal and a few stitches or sutures are placed to help the tissue heal. In the next few months, the bone will heal around the end of the root. Most patients return to their normal activities within the next 2-3 day. Post-surgical discomfort is generally mild to moderate.

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Do I really need endodontic surgery?

Root canals are very complex, with many small branches off the main canal. Even after the root canal treatment, infected tissue can remain in these branches at the tip of the tooth. This infected tissue can prevent healing and cause re-infection. During an apicoectomy, the root tip is removed along with the infected tissue. A filling is then placed at the tip of the tooth to create a seal preventing further infection. This procedure is generally done using local anesthetic. The endodontist will also use a microscope and check for any cracks or fractures in the tooth. The light and magnification from the microscope will allow the endodontist to see the area clearly.

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Apicoectomy preparation

A consultation for the procedure is necessary prior to treatment. The endodontist and one of our staff reviews everything you need to know about for the procedure. We recommend that someone drives you home after your surgery appointment. You may be given an antimicrobial mouth rinse, a medicine to reduce inflammation, and/or antibiotics to take prior to or after your appointment.

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After Surgery

The area around the surgery site is will be tender for a couple days and may bruise and swell. Pain can be controlled with pain medication. Ice the area to reduce swelling immediately after surgery for the 10-12 hours, alternating 15 minutes on 15 minutes off. Our staff will recommend what to eat and drink after the procedure. You will schedule a follow-up appointment for two weeks after the surgery so we can check healing and the tissues around the tooth and remove the sutures if applicable.

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