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.
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