Endodontic surgery is commonly referred to as apicoectomy. It involves removal of the infected root tip and surrounding inflammed tissue and placement of a root end filling in order to treat and preserve a tooth with a root canal re-infection. This is done in a surgical setting with the aid of a microscope.
After local anaesthetic is given, the gums are raised to expose the tooth and bone. The root and its surrounding structures will be inspected especially for the presence of any cracks or fractures. Curettage will be carried out and diseased tissues removed for biopsy if necessary. The affected root tip is then resected before the apical root canal is sealed with a root end filling.
If the affected root or tooth is deemed beyond surgical repair or treatment, the endodontist may advise to have it extracted instead and this can be done during the surgery on the same day.
Root canal treatment aims to eliminate bacteria and disinfect the tooth. Generally, most root canal treated teeth last as long as natural teeth if appropriately restored and regularly maintained. This includes home oral hygiene measures such as brushing and flossing and visits to the dentist for check-ups and scaling.
However, as the structure of the root canal system can be very complex, remaining bacteria may sometimes harbour despite best efforts to clean them out, giving rise to persistent infection later. Sometimes, recurrent decay, cracks or defective restorations can affect the root filling, eventually causing the root canals to be re-infected.
Symptoms that may indicate persistent or recurrent infection include persistent pain and tenderness or swelling of the gums in the area near the tooth despite previous root canal treatment.
Gum boil or sinus tract
Sinus tracing of a soft tissue swelling
When is endodontic surgery needed?
Endodontic surgery may be recommended:
If you have any pre-existing medical conditions, such as recent heart surgery or uncontrolled diabetes, your dentist may advise you to check with your medical doctor whether you are fit for the surgery.
As the surgery is done under local anaesthesia, generally minimal discomfort is experienced during the surgery.
There may be some pain, tenderness and bruising of the affected area after surgery when the anaesthetic wears off. Painkillers and mouth wash can be prescribed to alleviate these symptoms. Occasionally, antibiotics may be prescribed.
You will need to return in 3 to 5 days after the surgery for a review. The surgery site will be inspected, cleansed and the stitches removed. X-rays may be taken during this visit. The follow-up appointment to review bone healing is usually scheduled 6 months later.
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