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Endodontic Microsurgery (‘Apicectomy’)
Occasionally, conventional root canal treatment (through the top of the tooth) may not work or can not be performed, despite the best efforts of a Specialist endodontist. Reasons for this might be:
- Attempting to re-treat a previous root canal filling has a lower statistical success rate of 70-80% (compared to 95% success if it was performed properly the first time round)
- Re-treating the root canals from the ‘top’ of the tooth may be too destructive to the existing crown or bridgework
- Cleaning of the root canals may be technically extremely difficult or impossible due to a blockage or calcification
- Long-standing infection may be resistant to conventional root canal treatment. This is due to infection surviving outside the end of the roots. This will then require a direct surgical investigation and removal
What are the alternatives to surgery?
Unfortunately, the only other way to eliminate infection that persists at the end of the root(s) is by extraction of the tooth.
Your general dentist can explain to you all the reasonable options and alternatives to surgery and the Specialist endodontist can inform you of the success rate and costs of the surgery.
The Procedure
The whole procedure will be performed under surgical microscope with the latest digital imaging equipment. Sometimes it may be recorded for teaching purposes.
Essentially, the endodontist peels back the overlying gum tissue over the site of the root infection so that he/she can directly visualise the offending tissue. The inflamed tissue is then removed together with the infected root-end. A small filling is then place back up inside the root canal to seal the remaining root filling, and then the gum tissues are stitched back so that they can heal normally.
Over the first few weeks the gums will heal back to their normal appearance and over a period of months, the bone will heal round the end of the roots.
Stage 1
Stage 2
Stage 3
Stage 4
Courtesy of the AAE, "Your guide to Endodontic Surgery"
Will the surgery hurt?
The whole procedure is performed under local anaesthetic so that everything around the tooth is numb and you will not feel any pain. When the anaesthetic has worn off and for a few days after the procedure, there will be some soreness in the gums.
Evidence shows that taking an anti-inflammatory just before and after the treatment (e.g. 400 mg ibuprofen, "Nurofen Plus"), or if you have a medical condition that precludes you taking his type of painkiller (e.g. asthma, gastric ulcer) then 1000mg Paracetomol will help minimise the discomfort.
The endodontist will then review you again within the first a week to remove the stitches. The tooth will be reviewed again after 6 months assess how well the bone has healed at the end of the root.
For patients that have recently had surgery with Dr Bhanderi, please feel free to download this 'post-surgical care' guide.