Endodontic (Root Canal) Surgery

Endodontic (Root Canal) surgery can help save your tooth in a variety of situations. Root canal surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist (root canal specialist) to examine the entire root of your tooth, find the problem, and provide treatment.

Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If the tooth has this “calcification,” an endodontist (root canal specialist) may perform root canal surgery to clean and seal the remainder of the canal. Usually, a tooth that has undergone a root canal treatment can last the rest of your life and never need further root canal treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. In this occasion, surgery may help save your tooth.

Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of the root after a root canal treatment, your endodontist (root canal specialist) may have to perform an apicoectomy and often place a root-end filling.

Frequently Asked Questions about Endodontic Surgery

What is an apicoectomy and retrograde filling?

In an apicoectomy, the endodontist opens the gum tissue near the tooth to inspect the underlying bone and to remove any inflamed or infected tissue. The apex which is the very end of the root is also removed. The aim of this procedure is to remove the portion of the root where biofilm most likely resides.

After an apicoectomy, special ultrasonic instrument is used under dental operating microscope to remove the potentially contaminated root canal filling and prepare the root canal space in retrograde direction. Then, small filling with biocompatible material is placed into the prepared root canal space to seal the root end. The stitches or sutures are placed in the gingiva to help the tissue heal properly.

The bone healing around the resected end of the root is observed at the follow up visit a year after the apicoectomy in vast majority of the cases.

Are there other types of endodontic (root canal) surgery?

Other surgeries endodontists might perform include dividing a tooth in half (hemisection), repairing an injured root caused by resorption or perforation, or even removing one or more roots (root amputation). Your endodontist will be happy to discuss the effective root canal surgery your tooth needs.

In certain cases, intentional replantation may be performed. In this procedure, a tooth is extracted, root canal space is disinfected, shaped and filled while the tooth is out of the mouth, and then replanted back into its socket.

These procedures are designed to help you save your tooth.

Will the procedure hurt? Will there be pain after?

No, local anesthetics make the procedure tolerable and comfortable.

Of course, there may be some discomfort or slight swelling while the incision heals like 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?

Most of the time 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 engage in other activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

Does insurance cover endodontic surgery?

Each insurance plan can be different. Check with your employer or insurance company prior to treatment and obtain pre-treatment estimate or authorization.

How do I know the surgery will be successful?

When your dentist or endodontist is suggesting endodontic (root canal) surgery because he or she believes it is the best option for saving your own natural tooth even though there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make the best informed decision.

What are the alternatives to endodontic (root canal) surgery?

Generally, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent neighboring teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic (root canal) surgery is usually the most biologic and cost-effective option for maintaining your oral health.

No matter how effective modern tooth replacement options are, nothing is as good as your own natural tooth. You’ve already made an investment in saving your tooth with root canal treatment. Choosing endodontic surgery can help you to keep a healthy, functioning natural tooth for the rest of your life.