Surgical endodontics

Endodontic surgery involves surgical procedures to save a tooth that cannot be saved by nonsurgical root canal treatment.

Introduction

What is surgical endodontics?

Endodontic surgery involves surgical procedures to save a tooth that cannot be saved by nonsurgical root canal treatment.

Why is it done?

Endodontic surgery is needed for the following reasons:
  • A tooth that has undergone root canal treatment may not have healed properly or may have become infected and for this reason, surgery will be needed to save the tooth.
  • To diagnose symptoms that do not appear on x-rays, that may be due to a tiny fracture.
  • Sometimes calcium deposits make a root canal too narrow for nonsurgical instruments to reach, so endodontic surgery is used to clean and seal the root canal.
  • Surgery may be performed to treat damaged root surfaces or the surrounding bone.

What does it involve?

There are many surgical endodontic procedures to save a tooth, but the most common is called an apicoectomy. This procedure is used to treat inflammation and infection that persists in the bone around the end of a tooth, after root canal treatment. During the surgery the endodontist opens the gum near the tooth to look at the bone and removes any infected tissue, removing the end of the root along with it. The end of the root canal may be filled with a small filling and stitched. After a few months, the bone around the end of the root will heal. Other types of endodontic surgery can include:
  • Replantation; the tooth is extracted, treated and replanted back into its place.
  • Root repair
Candidates
In situations where a traditional root canal will not adequately treat a tooth infection, or when diagnostic techniques do not reveal the cause of your symptoms, our doctors will often recommend endodontic surgery. By undergoing endodontic surgery, we can examine the entire root of your tooth and remove infected pulp from the deep recesses (called canals) so that you can avoid extraction. Our endodontists are highly trained specialists who can identify good candidates for endodontic surgery at our Montgomery, AL, practice. If you are experiencing symptoms of advanced tooth decay, contact Oral & Maxillofacial Surgery Associates today and schedule a personal consultation.
Consultation
A consultation visit with an endodontist is important, as this type of appointment is one that allows them to understand more about what the patient needs in order to experience good oral health. Below is a list of some of the more important questions to ask an endodontist during an initial consultation visit.

Is a root canal procedure absolutely necessary?

Yes, a root canal procedure is necessary when there is an infection present inside of a tooth. Whenever the pulp inside of a tooth is infected, this infection needs to be treated in order for the patient to have a chance at saving their tooth. Tooth infections do not heal by themselves and instead need to be treated by a dental professional in order to remove the infection. If an infected tooth is not treated, the tooth will eventually be lost.

What pain management options do you offer?

Endodontists understand how to treat pain in their patients, and pain management is one of the main goals an endodontist has when treating their patients. This makes it a good idea for patients to ask about the different pain management options an endodontist offers, as this allows them to make a choice that is right for them. This includes finding out more about any pain management options available after undergoing endodontic treatment.

What should a patient do and not do before a procedure?

As with most dental procedures, there is a list of things that dental patients should do and not do before undergoing a particular dental procedure. Two examples of things to do before a procedure include eating a healthy meal and getting plenty of rest. A few examples of what not to do include taking painkillers without the dental professional’s approval, eating heavily or drinking alcohol.
Questions to Ask
A consultation visit with an endodontist is important, as this type of appointment is one that allows them to understand more about what the patient needs in order to experience good oral health. Below is a list of some of the more important questions to ask an endodontist during an initial consultation visit.

Is a root canal procedure absolutely necessary?

Yes, a root canal procedure is necessary when there is an infection present inside of a tooth. Whenever the pulp inside of a tooth is infected, this infection needs to be treated in order for the patient to have a chance at saving their tooth. Tooth infections do not heal by themselves and instead need to be treated by a dental professional in order to remove the infection. If an infected tooth is not treated, the tooth will eventually be lost.

What pain management options do you offer?

Endodontists understand how to treat pain in their patients, and pain management is one of the main goals an endodontist has when treating their patients. This makes it a good idea for patients to ask about the different pain management options an endodontist offers, as this allows them to make a choice that is right for them. This includes finding out more about any pain management options available after undergoing endodontic treatment.

What should a patient do and not do before a procedure?

As with most dental procedures, there is a list of things that dental patients should do and not do before undergoing a particular dental procedure. Two examples of things to do before a procedure include eating a healthy meal and getting plenty of rest. A few examples of what not to do include taking painkillers without the dental professional’s approval, eating heavily or drinking alcohol.
Risks and Safety

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.
Preparation

How can I prepare for endodontic surgery?

Before surgery is an option, your endodontist must go over your medical history and take x-rays to make sure that surgery is the last resort to saving the tooth. Before an apicoectomy, your endodontist will go over the procedure with you and give you a local anaesthetic to make the surgery as comfortable and pain-free as possible.

Post-operative care

Some discomfort and swelling can be expected after the surgery, as the tooth heals. The endodontist will recommend appropriate painkillers. Most patients can return to normal activities the next day, depending on the treatment.
Procedure Steps
For a proper understanding of endodontic surgery, knowing about the non-surgical endodontic treatment procedure, or root canal, is essential. A root canal is imperative when the infection or inflammation invades the delicate internal tissues of the tooth, called the pulp. This may be caused by severe tooth decay, repeated dental treatments or trauma to the tooth. Endodontic treatment is set to remove necrotic or damaged pulp, after which the tooth canal will be cleaned and filled up to keep the tooth intact. In some cases, the nonsurgical endodontic procedure may not be enough to save the tooth, so the dentist or endodontist may suggest endodontic surgery.
Recovery
Results
Glossary of Terms
Abscess – This is another word for a pimple or blister that forms around a tooth that is infected and may need a root canal. The appearance of an abscess is a sign that the root of your tooth is infected or decaying and as such, may require a root canal. Anesthesia – Dentists use this medication to numb a small area of your mouth to allow the root canal procedure to be completely painless. Apical micro-surgery – This is the last line of defense in healing an infected and/or decaying root of a tooth. The procedure is similar to root canals and retreatments in that it cleans the root of the tooth, however with this treatment, part of the root and all surrounding infected tissues are also removed. Apical Surgery – See apical micro-surgery Apicoectomy – See apical micro-surgery Cavity – A cavity forms when the enamel (the outer most layer of the tooth) erodes to the point of a small hole forming, which then allows decay to occur in the next layer of the tooth, the dentin. When the decay reaches the dentin, a cavity is formed to the point where it requires cleaning and filling by a dental professional. Crown – During the root canal process a portion of your tooth is removed. The result is the tooth is not as strong as it was prior to the procedure. To help strengthen the tooth a filling, or crown, is placed to ensure no additional damage occurs. Dentin – This is the second layer of the tooth underneath the enamel. When decay reaches the dentin a cavity is formed and must be filled by a dentist or dental professional. Enamel – This is the outer most layer of the tooth. It does not completely form in children until the age of seven. This is the reason kids are at higher risks for cavities. Endodontics – The science and practice specifically related to the roots and root canals of teeth. Endodontic Therapy – See root canal. Dr. Harris is trying to get away from the term “root canal” and the stigma attached to it. Endodontist – An endodontist is a dentist with additional years of education that provided them the ability to focus exclusively on root canals and root canal treatments. Extraction – When a tooth is infected and/or requiring a root canal an alternative treatment is to remove, or extract, the entire tooth. This is a procedure that was commonly used when dental technology was not as advanced as it is today. Typically, patients who opt to have their tooth extracted, and then choose to have the resulting hole filled in with a replacement tooth. The costs for an extraction with a tooth replacement and a root canal are very similar. Pulp – This is the blood supply and nervous tissue found inside the root of the tooth. Retreatment – Sometimes a traditional root canal treatment does not remove all the decay or infection; and sometimes an additional infection occurs after the root canal procedure. If this happens or if a patient has a particularly complex root anatomy that did not allow the original root canal treatment to be effective, a retreatment can be required. A retreatment will remove the crown or filling placed during the original root canal, re-clean and re-seal the tooth. Root Canal Retreatment – See retreatment Root – Tooth structure found below the bone that holds the tooth in place Root Canal – This term has two definitions. The first definition of this term is related to the anatomy inside the tooth where the pulp tissue exists. The second definition is related to the practice of properly removing decay or infection in the root canal area to avoid further dental and/or health issues, more recently referred to as endodontic therapy. Root Canal Surgery – See apical micro-surgery
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