Endodontic surgery

When surgery can save a tooth

Most root canal care happens from the inside, through the top of the tooth. Surgery reaches the root from the outside, through the gum, and it can save a tooth when treatment from the inside isn’t enough.

• Finding a hidden problem. If a tooth keeps hurting but nothing shows on your x-rays, it may have a tiny crack or a canal that couldn’t be found during treatment. Surgery lets Dr. Brasseale examine the whole root, find the problem and treat it.
• Reaching a blocked canal. Calcium deposits can narrow a canal so much that instruments can’t reach the end of the root from inside the tooth. Surgery cleans and seals that last part of the canal from the outside.
• Saving a treated tooth that hasn’t healed. Most teeth that have had a root canal never need more treatment. Occasionally one doesn’t heal, or becomes painful or infected months or even years later, and surgery can help save it.
• Repairing the root or the bone. Surgery can also treat damaged root surfaces or the bone around them.

The most common endodontic surgery is an apicoectomy, also called a root-end resection. It treats inflammation or infection that stays in the bone around the tip of a root after a root canal.

What happens during your apicoectomy

1. Numbing. Dr. Brasseale numbs the area around the tooth thoroughly with a local anesthetic.
2. Reaching the root tip. He gently moves the gum aside to reach the bone over the root, then removes the inflamed or infected tissue along with the very tip of the root.
3. Sealing the root. He prepares the end of the root and seals it with a small bioceramic root-end filling.
4. Closing. A few stitches hold the gum in place while it heals.

Over the following months, the bone heals around the end of the root.

Dr. Brasseale performs the whole procedure under the surgical operating microscope, and that matters. A review of 21 studies found that root-end surgery done with magnification and modern microsurgical methods succeeded in 94 percent of cases, compared with 59 percent for the older technique.

What recovery feels like

Some discomfort and slight swelling are normal while the area heals. Dr. Brasseale will recommend or prescribe pain medicine, and antibiotics if you need them, and you go home with written instructions for the days after surgery.

You can usually return to work and your normal routine the next day. Before your appointment, ask us whether you can drive yourself home, so you can arrange a ride if you need one. Follow your aftercare instructions, and call us with any questions after surgery or if discomfort lasts more than a few days.

Saving the tooth instead of replacing it

When an apicoectomy can save the tooth, it’s usually the more conservative and cost-effective choice, and your own tooth keeps working. Often the only other option is removing the tooth. A removed tooth then needs an implant, a bridge or a removable partial denture so you can chew well and the teeth beside it don’t shift, and those options involve surgery or work on healthy teeth nearby.

Dr. Brasseale will tell you whether surgery, retreatment or another option fits your tooth best.