Endodontic Surgery

Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

Commonly Asked Questions:

I am allergic to latex. Is this a problem?  No, our office is latex-free.

My office just took an x-ray, why do you need to take one?  The more information we gather, the better we are able to care for you and your tooth. Our digital imaging program also allows us to measure the tooth, helping us to treat the tooth more quickly during treatment.

Will I need a crown after my root canal?  Do not be surprised if your dentist recommends a crown when you return to them. The tooth is weaker after root canal treatment and a crown is able to protect against breakage or fracture. If you already have a crown, you may only need a permanent filling.

Will there be pain after the root canal?  You should expect some minor biting and pressure sensitivity for 3-5 days after the root canal treatment. Over-the-counter medications, such as Ibuprofen or Advil, should help alleviate this.

What options does your office offer to help me relax during my treatment?  We are equipped to offer Nitrous Oxide Analgesia, also known as laughing gas. This affects everyone differently. Some patients get very sleepy on nitrous, while others are simply more relaxed. We can also offer intravenous moderate conscious sedation. for more information, please visit our Sedation Options page. If you are interested in either of these options, we would be happy to discuss it with you at your consult visit.

Why do you place a temporary filling?   You will be sore after your root canal treatment. We prefer to place a filling that is occlusally reduced so you do not bite too hard on it while you are healing. You will heal much quicker after treatment if the tooth is not occluded on.  Also, by waiting to have the permanent filling placed, we are better able to diagnose what could be causing symptoms later on.

Why can't I just take Antibiotics?  Antibiotics are carried in the blood stream to problem areas in the body so they can do their job. After a tooth has died, there is no blood flow into a tooth so the antibiotics never reach the source of the problem. Even though antibiotics do not solve the underlying problem, they can still be useful in relieving symptoms.

In some cases, your root canals are unusually narrow or blocked (sometimes by calcium deposits or other debris), making a repeated root canal procedure ineffective. In other cases, a root canal procedure may fail or an infection recurs after a long period of time. In these cases, endodontic surgery may be needed and is the only alternative to tooth extraction.

Endodontic surgery is usually called for under the following circumstances:

  • Acute pain.
  • Diagnosis of canals and inner tooth structures that cannot be performed non-surgically.
  • Conventionally blocked root tips.
  • Cracked roots.
  • Perforated root tips.
  • Persistent cysts.
  • Removal of a debris from a previous root canal that could damage root tips if left inside the tooth.
  • Unusually formed molars, incisors, and first premolars, which often have complex and tiny canal divisions that cannot be treated with conventional endodontic treatment.

    The most common types of endodontic surgical procedures are apicoectomy, intentional replantation, hemisection, and retrosealing. Here's a brief look at those procedures: Apicoectomy
    In some cases, surgery is required to closely examine the tiny canals that are not visible to the naked eye. Only through such procedures can an accurate diagnosis be made. The most common non-diagnostic endodontic surgical procedure is an apicoectomy, or root-end resection.

    An apicoectomy is often performed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.

    An apicoectomy often involves removal of the end of the root of the tooth. During the procedure, the gingival (or gum) tissue near the tooth is opened with an incision. This allows the underlying bone to be examined and inflamed or infected tissue to be removed.

    Afterwards, a small filling may be placed to seal the end of the root canal, and a few stitches or sutures are placed in the gum tissue to aid healing.

    Intentional replantation

    Intentional replantation involves extracting the affected tooth, repairing the tooth endodontically outside the mouth, and re-inserting, or re-planting, the tooth in its socket.

    Hemisection
    Hemisection is a surgical procedure in which a single root of a multi-rooted tooth is removed because it cannot be repaired or treated, or bone loss around an individual root (usually as a result of periodontal disease) makes conventional endodontic treatment impractical. Hemisection is usually a procedure called for as a last resort before extraction.

    In other cases, the front root of a lower second molar may be removed and used as a bridge anchor to replace a missing first molar, thus preventing the need for a partial denture or dental implant.

    Retroseal
    Retrosealing is often performed to re-seal the canals following an apicoectomy. Retroseal is the process that finally resolves most endodontic failures.