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Root Canal Surgery, Endodontic Surgery, Apicoectomy (Apico) and Retrofill (retro) or

Surgical Endodontic Therapy

When is this procedure done?

Nonsurgical endodontic treatment alone cannot maintain some teeth.  Endodontic surgery includes any surgical procedure used to remove inflammation and/or infection from your roots and surrounding areas or to repair a given problem. Endodontic Surgery can help maintain your tooth in situations such as:

Diagnosis.  In particular for root fractures. If you have persistent symptoms which do not appear on a radiograph or x-ray, your tooth may have a tiny fracture. In many cases, surgery allows the visualization of your root to determine the problem. Vertical root fractures begin at the end of the root typically and extend toward the chewing surface. They often go unnoticed until surrounding bone and gums become inflammed/infected. Treatment for a single rooted teeth is usually extraction. Multirooted teeth may have the affected root removed in some cases. See also Vertical Root Fractures.

Unable to treat to near the end of the root. Sometimes narrow channels, calcium deposits, or extremely torturous canal systems are unable to be treated to the end. In some cases, there are several branches near the end of the root that were not treated in the previous nonsurgical treatment(s).

Unable to treat to additional canals.  Due to variable anatomy, treating all the canals in a tooth can be more of a challenge then possible with today’s technology nonsurgically.

Failure to heal after nonsurgical treatment. In a few cases, a tooth may fail to heal or the tooth becomes painful/diseased years after the initially successful treatment even when the original treatment is done to ideal. While there may be many reasons, it potentially may be due to a cyst that must be mechanically removed or bacteria that have embedded themselves at the end of the root causing persistent infection.

Damaged root surfaces or surrounding bone. We don’t understand all the details, but sometimes the body will begin to eat a hole into the tooth. We call the process resorption. Depending on the location, it is commonly repaired surgically.

What is the most common endodontic surgical procedure or ‘root canal surgery’?

The most common surgical procedure is called root end resection.  We usually cut off the very tip of the root and place a filling at the end of the root to help seal the root structure. This used to be called apicoectomy and retrofill or “apico” and “retro”. The American Association of Endodontists decided that apicoectomy was not very patient friendly so it retermed the procedure root end resection. They feel it describes the procedure better.

The Anatomy of a Tooth with

Previous Unsuccessful Endodontic Therapy

What Happens During Endodontic Surgery?

A local anesthetic will be given. An opening is made near the tooth by reflecting the gum tissue away from the tooth.  This allows us to see the area and surgical portion of the treatment is completed. If root end resection is completed we remove the inflammed and/or infected tissue, cut off the root end and place a filling to help seal the end of the root. To me, it’s more important to do it the very best we can then to meet a specific time criteria. Let’s look at the basic steps for root end resection with root end filling.

The Root End Resection with Root End Filling Procedure

Gum Tissue Opened

Tissue Removed

Root End Resected

Root End Filled

Bone Healed

Gum Tissue Opened Tissue Removed.  Gum tissue is reflected near the tooth to give access to the tissue at the end of the root. Then the inflammed and/or infected material is removed.

Root End Resected Root End Filled. The end of the root is removed since it is usually the problem area. Sometimes the end of the root may have embedded bacteria in the rooth structure or branching of canal system which was untreatable with current techniques. A filling helps seal the end. I usually use MTA or Mineral Trioxide Aggregate which is really sterilized for medical use portland cement. It is one of the most biologically compatible materials ever devised for use in dentistry. This material was very difficult to place until I designed a set of carriers to place it. See News

Bone Healed.  Over a period of months, sometimes years, bone heals around the end of the root. This means after the surgery is completed, we usually follow up until it heals (or you stop comming to us!)

What kind of Materials are placed in the Root end filling process?

A sealing material such as Mineral Trioxide Aggregate (MTA or Portland Cement), Zinc Oxide and Eugenol, and/or composite/glass/resin ionmer (glass and organic acid +/or plastic resin). It will NOT contain amalgam when completed in our office.

I’ve never heard of this ‘MTA’ stuff. What else is it used for?

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