When is Endodontic Surgery recommended?

• when the root canal treated tooth did not heal as expected despite the most favourable treatment being done
• as an alternative treatment, when conventional non-surgical retreatment is not recommended
• in conjunction with conventional root canal retreatment
• to explore cracks or other damage to the root or tooth
• to confirm a diagnosis or remove cysts or growths

Why do some root canal teeth fail?
Root canal treatment aims to eliminate bacteria and disinfect the tooth. However, as the structure of the root canal system can be very complex, removing bacteria to harbour despite the best efforts to clean them out, giving them rise to persistent infection later.

Uncontrolled decay, cracks or defective restorations may also affet the root filling, eventually causing the root canals to be re-infected. Some cysts at the root end may not heal even with root canal treatment.

What is root-end surgery?
Commonly referred to as apicoectomy or root-end resection, it involves removing the infected root tip and the surrounding infection or inflammed tissues. This is done in a surgical setting with the aid of a microscope. After local anaesthetic is administrated, the gum is lifted to expose the bone and tooth beneath. The root and its surrounding area will be inspected especially for the presence of any cracks or fractures. Curretage and disinfection are then carried out. If necessary, diseased tissues are removed and sent for biopsy. The affected root tip is then cut away, the apical root canal is re-sealed with a root-end filling and the gums are stitched back.

Sometimes, when the affected root or tooth is deemed beyond surgical repair or treatment, it may be extracted during the same surgery.

Does root-end surgery hurt?
Under local aneathetic, generally no pain is experienced during surgery. However, there may be some pain, tenderness and bruising of the affected area after surgery when the anaesthetic wears off. Painkillers, antibiotics and mouth wash may be prescribed to alleviate these symptoms.

What next?
You will need to return in 3 to 5 days' time for the stitches to be removed. 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.