• Apicoectomy | An overview of endodontic surgery.


      Why would I need Endodontic Surgery? Usually, a root canal, post and crown are all that is required to save infected or abscessed teeth. Occasionally, a non-surgical root canal procedure will not be sufficient to heal the tooth and your general dentist or endodontist will recommend surgery.

      The most common causes for root canal failure are:
      1) Recurrent infection at the tip (apex) of the root. This may be due to small accessory canals. Accessory canals usually cannot be seen on dental radiographs and often cannot be treated by conventional root canal therapy. Persistent bacterial infection in the surrounding apical tissue or bone at the root tip can also cause recurrent infection.
      2) Fracture of the tooth root. There may be a very fine fracture in the root of the tooth that may not show up on dental radiograph. Root fractures can be difficult to diagnose. If a root fracture is present, nothing can save the tooth, it must be extracted.

      When conventional root canal treatment fails there are three treatment options available:
      1) Attempt to repeat the root canal (this often has a poor prognosis).
      2) Perform a surgical root canal (apicoectomy with retrograde amalgam).
      3) Extract the tooth.

      What is an Apicoectomy? An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. A small window is created in the bone in the region of the root apex (tip of the root). Damaged tissue in the bone around the end of the root tip is removed. The tip of the root is removed and a small preparation is made in the root to receive an amalgam (silver) filling. The amalgam filling (retrograde amalgam) is placed at the tip of the root to seal the canal and prevent re-infection of the surrounding bone. The gum is sutured with small dissolvable sutures. The bone naturally heals around the root over a period of months restoring full function.

      Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended. Please review our section on: General post-operative care for additional instructions.

      An apicoectomy can be accomplished comfortably under local anesthesia, intravenous general anesthesia, intravenous conscious sedation, nitrous oxide analgesia or oral sedation and local anesthesia. Our doctors will help you to select the anesthetic technique which is best suited for you during your consultation visit.
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