Endodontic surgery is one method of retreating endodontically treated teeth that have failed to respond to the initial non-surgical root canal treatment. It is typically indicated for teeth that have a poor prognosis for non-surgical retreatment. This could be related to teeth that have post-retained crowns, which would be destroyed when the post is removed. Just the process of removing the post could result in root fractures. Teeth that cannot be negotiated (for example, a broken endodontic file) or otherwise have obstructed canals as evidenced by radiographs are also candidates for surgical root canals. The primary purpose of endodontic surgery is to improve the seal of the root canal system. At times, we perform surgery as a diagnostic procedure to see what the cause of the problem is, after which we either fix the problem through root canal treatment or extract the tooth. The patient is spared the time and expense of being referred to another surgical office for an additional consultation and possibly a second surgical procedure. We have the advantage of using cone beam technology to see the tooth in multiple views and in three dimensions. Many times, we prevent the patient from undergoing unnecessary procedures that will not fix the tooth.
The surgical procedure is performed in our office. A local anesthetic is used to make the procedure painless. Some patients prefer to be sedated, which we accomplish with either oral medication or IV sedation. For surgeries, an incision in the gum tissue is made over the teeth in front and back of the offending tooth. The gum tissue is gently lifted so that the apex of the root can be exposed. The overlying bone is removed, exposing the root ends. In the absence of fractures, the root ends are reshaped (apicoectomy), and the root canal material is removed with a specialized ultrasonic instrument. The diameter of the canal is enlarged and a root end cement is placed in the preparation, sealing the canal (root end filling or retrograde filling.) It is rare that the lesion at the end of the root is cancer, however, we don’t treat your health casually, so any tissue that is removed is collected and sent to an oral pathologist for evaluation. Sutures are placed to reposition the gum tissue and are removed in 7-10 days.