Endodontic surgery, sometimes called surgical endodontic treatment, may be considered when a problem affecting the root of a tooth cannot be adequately managed through conventional root canal treatment or root canal retreatment.
One of the most common forms of endodontic surgery is an apicoectomy, also known as root-end surgery or root-end resection. The procedure provides direct access to the area around the end of a tooth root so that the endodontist can assess and treat the affected tissues.
At JCV Endodontics in Leederville, Perth, the decision to consider surgery is based on the individual tooth, your symptoms, previous treatment, clinical findings and diagnostic imaging. Surgery is not appropriate for every tooth, and reasonable alternatives are discussed before treatment is undertaken.
Most root canal treatment is performed through an opening made in the crown of the tooth. This allows the endodontist to clean, disinfect and seal the root canal system from inside the tooth.
Endodontic surgery approaches the root from a different direction.
A small opening is made through the gum near the affected tooth so the endodontist can access the tissues and bone surrounding the end of the root. Depending on the diagnosis, treatment may involve removing inflamed or infected tissue, removing a small portion of the root tip and sealing the end of the root canal.
The exact procedure varies according to the tooth and the reason surgery is being considered.
An apicoectomy is a type of endodontic surgery involving the tip, or apex, of a tooth root.
During the procedure, the gum is carefully moved to provide access to the area around the root. A small amount of tissue and, where necessary, bone may be removed to reach the affected area.
Inflamed or infected tissue around the root end can then be removed. A small portion of the root tip is generally removed and the end of the root canal may be prepared and sealed with a root-end filling.
The gum is repositioned and sutures are placed to support healing.
Endodontic surgery may be considered in selected circumstances, including when:
The presence of pain or an abnormality on an X-ray does not automatically mean surgery is required. Assessment is needed to determine the likely cause and the reasonable treatment options for the individual tooth.
A previously root canal-treated tooth that develops symptoms does not necessarily require surgery.
In some cases, non-surgical root canal retreatment may allow the existing root canal filling to be removed so the canal system can be reassessed, cleaned and treated again.
In other circumstances, accessing the problem through the tooth may be difficult, undesirable or unlikely to address the area of concern. Surgical treatment may then be one option considered.
Factors that can influence the decision include:
Your endodontist can explain why retreatment, surgical treatment, monitoring, extraction or another approach may or may not be appropriate for your particular tooth.
Before recommending surgical treatment, the endodontist assesses the tooth and the surrounding tissues.
This may include discussion of your symptoms and dental history, examination of the tooth and review of appropriate diagnostic imaging.
The purpose of this assessment is to establish the likely diagnosis and consider the available treatment options rather than assuming that surgery is required.
You should also tell the practice about relevant medical conditions, medications, allergies and other health information before treatment.
Where surgery is being considered, the procedure, expected recovery, relevant risks, limitations and alternatives can be discussed before you decide whether to proceed.
The details vary between teeth, but a typical root-end procedure may involve the following stages:
Local anaesthetic is used to numb the treatment area.
A small incision is made in the gum and the tissue is carefully moved to provide access to the bone and root.
The tissues around the end of the root are examined. Inflamed or infected tissue can be removed and a small portion of the root tip may be removed.
Where required, the end of the root canal is prepared and sealed with a root-end filling.
The gum tissue is repositioned and sutures are placed.
Healing of the gum occurs considerably sooner than changes within the surrounding bone, which can continue over a longer period. Follow-up examination or imaging may therefore form part of monitoring after treatment.
Local anaesthesia is used during endodontic surgery to numb the treatment area.
Individual experiences vary, and a completely pain-free experience cannot be guaranteed.
Temporary tenderness, swelling or discomfort can occur after surgery as the tissues heal. Your endodontist will provide post-operative instructions appropriate to the procedure and your individual circumstances.
Patients who are concerned about dental treatment can also discuss whether a sedation option is clinically appropriate.
Recovery varies according to the tooth, the extent of treatment and the individual patient.
Some swelling, tenderness or bruising can occur following oral surgery. Your endodontist will explain how to care for the surgical area and what activities may need to be modified temporarily.
Follow the post-operative instructions provided specifically for you.
If symptoms become severe, progressively worsen, bleeding does not settle, or you are concerned about your recovery, contact the practice for advice.
Like other surgical procedures, endodontic surgery has risks and limitations.
Depending on the tooth and the procedure, these may include:
For some teeth, the position of nearby structures such as sensory nerves or the maxillary sinus may also be relevant to treatment planning.
The nature and significance of these risks vary from person to person and from tooth to tooth. Your endodontist can discuss those that are relevant to your proposed treatment.
JCV Endodontics is a dental practice in Leederville, Western Australia. Endodontic treatment is provided by Dr Juan Camilo Villegas, a dentist with specialist registration in endodontics with the Dental Board of Australia. Content on this site is general information only and does not replace individual clinical advice from your practitioner.
An apicoectomy is one type of endodontic surgery. It involves treating the area around the end of a tooth root and usually removing a small portion of the root tip. Other forms of endodontic surgery may be considered in different clinical circumstances.
A previously treated tooth can occasionally develop persistent or recurrent inflammation or infection around the root. Surgery may be considered when accessing or treating the problem through the existing root canal is not appropriate or sufficient.
No. Pain can have several causes. Assessment is required before deciding whether retreatment, surgery, another dental treatment or monitoring is appropriate.
Sometimes. Whether retreatment is appropriate depends on the cause of the problem, the existing root canal treatment, restorations, anatomy and other clinical factors.
Endodontic surgery is commonly performed using local anaesthesia. Sedation may be considered for some patients depending on their circumstances and clinical suitability.
This depends partly on the type of anaesthesia or sedation used and your individual circumstances. Patients receiving sedation must follow the specific instructions provided regarding transport and activities after treatment.
Soft tissues generally begin healing relatively quickly, while changes in the bone around the root can continue for a longer period. Your endodontist will advise whether follow-up examination or imaging is appropriate.
Further assessment would be required. Depending on the circumstances, options may include additional treatment, monitoring or extraction
This page provides general information about surgical endodontic treatment and does not replace individual diagnosis, informed consent or advice from your treating dental practitioner.
If you would like to learn about root canal treatment, then use the link below.