Endodontic Surgery - With proper care, most teeth that have had endodontic treatment can last as long as other natural teeth.

In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment. New trauma, deep decay or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover very narrow or curved canals that could not be treated during the initial procedure.

Who performs endodontic surgery?
All dentists received training in endodontic treatment in dental school. However, because endodontic surgery can be more challenging, many dentists refer patients needing surgery to endodontists.

Endodontists are dentists with at least two additional years of advanced education and training in root canal techniques and procedures. In addition to treating routine cases, they are experts in performing complicated procedures including surgery. They often treat difficult cases such as teeth with unusual or complex root structure or small, narrow canals. This special training and experience can be very valuable when endodontic surgery is necessary.

Why would I need endodontic surgery?
Surgery can help save your tooth in a variety of situations.

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 root canal treatment. In such a case, surgery allows your endodontist to examine the root of your tooth, find the problem, and provide treatment.

Sometimes calcium deposits make a canal too narrow for the cleaning and shaping instruments used in root canal treatment to reach the end of the root. If your tooth has this, your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.

Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may fail to heal. The tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.

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

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Endodontic surgical procedure - The most common surgical procedure is called an apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after endodontic treatment, your endodontist may perform an apicoectomy. In this procedure, the endodontist opens the gum tissue near the tooth to expose the underlying bone and the infected tissue is removed.

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The very end of the root is also removed and a small filling may be placed to seal the root canal. A few stitches or sutures are placed in the gum to help the tissue heal properly.

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Local anesthetics make the procedure comfortable and most patients return to their normal activities the next day. Over a period of months, the bone heals around the end of the root.

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Are there other types of endodontic surgery?
Other surgeries endodontists perform include repairing an injured root, removing one or more roots or in very complex cases, a procedure called intentional replantation. These procedures are all designed to help you save your tooth. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

What are the alternatives to endodontic surgery?
Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with a bridge, removable partial denture or implant to restore chewing function and to prevent adjacent teeth from shifting. These procedures can be far more costly and time consuming than saving the natural tooth through endodontic surgery.

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