Endodontic treatment is also called root canal therapy. This type of procedure is performed in order to save the tooth that has decay that extends into the pulp of the tooth. In most situations endodontic therapy is fairly reliable. However, there are instances when root canal treatment fails. In such cases, a surgical root canal treatment may be performed in order to try to save the tooth and avoid extraction. A surgical root canal treatment is also called an apicoectomy.
During this procedure, the infected tip of the tooth root is removed and a filling is placed in the remaining portion of the root. This is done to seal the tooth from the surrounding bone. This procedure is performed in the office using either local anesthesia or IV sedation techniques.
This procedure is the last attempt to save a failing tooth. Your dentist or endodontist will tell you if you need to have this procedure. Dr. Nickel and Dr. Steinberg have much experience in performing surgical endodontic treatment. If your dentist thinks that you may need this procedure, our doctors will be able to evaluate and treat you.
Why would I need Endodontic Surgery? Generally, a root canal is all that is needed to save a tooth with infected or exposed pulp. Occasionally, this non-surgical procedure (the root canal) will not be sufficient to heal the tooth and your endodontist or general dentist will recommend endodontic surgery. The tip of the tooth root is called the apex; “ectomy” at the end of a word implies removing something. Therefore, an apicoectomy implies the surgical removal of the tip of the root of a problem tooth. Additionally the infected area in the bone is removed.
This surgical procedure can also be used to locate root fractures or hidden canals that do not appear on x-rays but still cause pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure.
The above diagram illustrates this procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection and seal the canal. The gums are then sutured. The bone can then heal around the root over a period of months restoring full function. Careful follow up with dental x-rays and clinical examination is necessary to confirm that healing is occurring. Your surgeon will schedule follow up visits at one week, and 3 months to monitor progress.
Following the procedure, there may be some discomfort and swelling while the incision heals. This is normal for any surgical procedure. Application of ice on the affected side of the face off and on every 10 minutes after surgery, for the first 24 hours, will help minimize the swelling. To alleviate any discomfort, you will be given a prescription pain medication. If you have pain that does not respond to medication, please call our office. You may also be given an antibiotic to help eliminate and/or prevent further infection in the area. This should be taken until completely gone regardless of the presence of pain.
This procedure may be performed using local anesthesia or sedation. There are usually no restrictions after the procedure concerning driving or returning to work. If you have requested nitrous oxide (laughing gas) or IV sedation, you will receive special instructions at your consultation appointment about driving and recuperation after the procedure.
It is appropriate to eat a light meal and drink fluids before your surgical procedure unless you have elected an IV sedation. In those cases you must have an empty stomach for 6 hours before your procedure. You should also brush and floss after eating and prior to your arrival for your surgical appointment.
Continue all medications for blood pressure or thyroid problems and any other conditions as recommended by your physician. If you are a diabetic, you should ask your surgeon for special instructions about your pre-operative diet and how to take your insulin or oral hyperglycemic medicines. If there is a question, please call our office prior to your appointment.