Endodontics, or root canal therapy, is employed when the nerve supply to a tooth has been irreversibly affected by damage or decay. It is a way to prevent or help resolve a dental infection and save a natural tooth from extraction. A root canal is performed when there is enough sound root and crown structure remaining to eventually restore form and function to the involved tooth.
Inside every tooth is either a single central chamber or multiple ones that contain connective tissue, a nerve supply, and blood vessels. These core tissues, known as the dental pulp, help your tooth to grow and mature before it emerges into the mouth. A root canal procedure is required when this dental pulp is irreversibly damaged or has died.
Root canal therapy involves cleaning and shaping each canal, and then filling them with a special inert material. Following this they are sealed to prevent any subsequent infection. Once root canal therapy has been completed, the tooth should be fully restored as recommended.
In some cases, a tooth that has had a root canal, which did not sufficiently heal or has become re-infected, is not a candidate for endodontic retreatment. For these teeth a minor surgical procedure that treats the infection from the root-end of the tooth, which is known as an apicoectomy, may be indicated. An apicoectomy is an excellent next step procedure to preserve a previously treated tooth, eliminate a dental infection, and to restore the health of the surrounding tissues. It is most useful in cases where fractures or hidden canals still cause pain or infection around a treated tooth, as well as when an endodontic retreatment procedure is not recommended because it may further weaken and jeopardize the tooth.
An apicoectomy may be performed under local anesthesia. It is typically a straightforward procedure during which an incision is made in the gum tissue above the root of the involved tooth. This is to expose the inflamed or infected tissue surrounding the root tip of the tooth. Once uncovered, the damaged tissue in the area is removed along with a few millimeters of the tooth’s root tip. A biocompatible filling material is then placed in the end of the remaining portion of the root to seal it and prevent any possibility of reinfection. The gum tissue flap is put back into place and sutured to complete the procedure.
Post-surgical discomfort is generally mild, and you may have some swelling in the area. Most patients return to their normal activities very quickly. If needed, apply a cold compress to reduce discomfort and swelling after the procedure. The appropriate pain medication will be prescribed or recommended. If your discomfort does not respond to medication, or other symptoms that concern you develop, please call our office.
Prior to undergoing an apicoectomy the dentist will discuss all the risks and benefits of the procedure. If during the course of an apicoectomy, any significant fractures are discovered in the tooth that changes the prognosis, you will be immediately advised.