Sometimes a non-surgical root canal procedure is not enough to save the tooth. Several reasons can be to blame such as bacteria not being completely removed from the canals or poorly placed temporary fillings that leak. Both culprits allow bacteria back into the canal to infect or reinfect the tooth. Bacteria will multiply and begin to cause pain. However, there are many surgical procedures that can be used to save a tooth.
The most common surgery 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, your endodontist may recommend an apicoectomy. This surgery allows the endodontist to enter the tooth’s tooth from the bottom, rather than the top.
During the microsurgical procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and tissue. Then, the endodontist removes the inflamed/infected tissue from the bone at the root of the tooth and removes the very end of the root as well. The surgery may also be needed to remove calcium deposits in root canals. A small filling may be placed at the end of the root and stiches or sutures are placed to help tissue heal. The bone can then heal around the end of the root. The apicoectomy is performed in the endodontist’s office with local anesthetics used to make the procedure comfortable and post-surgical discomfort is typically minimal.
Endodontic surgery can also be used to locate small fractures or hidden canals that weren’t detected on x-rays or during previous treatment.