Root Canal Surgery
If ordinary root canal treatment (endodontic therapy) has been unsuccessful in
eliminating the infection in a tooth, sometimes root canal surgery may be
required.
Endodontic treatment is performed when the inner tissue, the pulp tissue,
of a tooth is infected. In this treatment, the infected pulp tissue is
removed and is replaced with an inert substance, usually gutta percha.
If the apical seal is inadequate, bacteria can get in and out of the root
canal space and the infection will be renewed. When this happens, you will have a
tooth abscess, and it is
said that the treatment has failed.
There are two remedies available for treating a
failed root canal:
Re-treat the tooth, removing the old gutta percha, improving the
preparation inside the tooth, and placing new gutta percha in an attempt
to get a better apical seal. Or you can have root canal surgery.
With this treatment, the dentist enters through the gum and bone
directly to the end of the root, or what is called the apex. The very tip
of the root is then removed. When this tip is the source of the infection,
this can often cure the infection. The name for this endodontic surgery
procedure is an apicoectomy, which means the removal of the apex. It is
easiest to perform on teeth that are closest to the front of the mouth.
Often the tips of the roots of the teeth are very close to the surface of
the gum. While the description of the surgery sounds awful, it is actually
often a very simple procedure with minimal post-operative swelling and a
short recovery time. Patients can often return to their normal activities
the next day.
What is a retrofill?
Sometimes, accompanying the apicoectomy, the dentist will place a small
filling at the end of the root, called a retrofill. The purpose of the
retrofill is to help seal this opening from any bacteria leaking in or
out.
When the failure is on a lower molar, surgery may not be an option. Not
only are the roots of these teeth difficult to get to surgically, but they
also lie very near the nerve that goes to the lower teeth and the lip.
Surgery that risks damage to this nerve may not be wise.
While surgery is often successful, there are many times when it is not
successful. The chance for success for surgery is probably somewhere
between 50% and 75%. It's best for patients to go into the surgery braced
for the possibility that the treatment may fail and the tooth will have to
be extracted.
Just because there is post-operative
root canal pain doesn't mean that
surgery is required. Post-operative pain is not uncommon and may not
indicate that anything is wrong.
Read Dr. Hall's blog post about a broken root canal file.
