Why do I need endodontic surgery?

To understand endodontic surgery, it helps first to know something about the nonsurgical endodontic procedure, or “root canal.” Root canal treatment is necessary when the soft inner tissue, or “pulp,” of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth, or an injury to the tooth. Root canal (endodontic) treatment removes the damaged pulp. Then the tooth’s canals are cleaned and filled to help preserve the tooth.

In a few cases, however, root canal (nonsurgical endodontic) treatment alone cannot save the tooth. In such a case, your dentist or endodontist may recommend surgery.

Who performs endodontic surgery?

All dentists received training in endodontic treatment in dental school. However, because endodontic surgery can be more challenging than providing nonsurgical treatment, many dentists refer patients needing surgery to endodontists.

Endodontists are dentists with at least two additional years of advanced education and training in root canal techniques and procedures. In addition to treating routine cases, they are experts in performing complicated procedures including surgery. They often treat difficult cases—such as teeth with unusual or complex root structure or small, narrow canals. This special training and experience can be very valuable when endodontic surgery is necessary.

Why would I need endodontic surgery?

Surgery can help save your tooth in a variety of situations.

• Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment. 
• Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification,” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
• Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
• Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common 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 have to perform an apicoectomy.

What is an apicoectomy?

Removal of the  very end of the root is called apicoectomy. In this procedure, the endodontist opens the gingival tissue near the tooth to examine the underlying bone and to remove any inflamed or infected tissue.

A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.

Over a period of months, the bone heals around the end of the root.

Are there other types of endodontic surgery?

Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.

These procedures are designed to help you save your tooth.

Will the procedure hurt?

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.

Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

Can I drive myself home?

Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?

Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

Does insurance cover endodontic surgery?

Each insurance plan is different. Check with your employer or insurance company prior to treatment.

How do I know the surgery will be successful?

Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for saving your own natural tooth.  Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?

Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.

No matter how effective modern artificial tooth replacements are—and they can be very effective—nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life

Surgical Preoperative Instructions

Post Surgical Care