Sometimes, non-surgical root canal therapy is not enough to save your tooth and we may recommend endodontic microsurgery. Endodontic surgery success has dramatically improved the last decade due to improved visibility with microscopy, improved sealing materials, improved armamentarium and improved imaging. Surgery can be done to locate small fractures or hidden canals previously undetected or for canals that cannot be cleaned out due to excessive calcium deposits or for canals that cannot be fully cleaned out with non-surgical treatment. Sometimes, surgery is indicated if there is an additional infection outside the root damaging root surfaces or the surrounding bone of the tooth.
There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which may be needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.
After applying good local anesthesia, the gum tissue is opened slightly and infection or any inflamed tissue is removed. The root end is removed and sealing material is placed at the end of the root canal. Few stitches are placed to help heal the tissue and you must return for post-operative evaluation and suture removal. In the next few months, the bone will heal around the end of the root(s). Most patients return to their normal activities within the next few days and post-surgical discomfort is generally quite mild.