Apical Microsurgery

Why would I need Endodontic Surgery?

Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an Apical Microsurgery or root-end resection.

What is an Apical Microsurgery?

The video on the right illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. Occasionally, a bone graft and membrane may need to be placed in the surgical site. The bone naturally heals around the root over a period of months restoring full function.

Apical Microsurgery
1. Infected Tissue
Apical Microsurgery
2. Tissue Removed
Apical Microsurgery
3. Suture Placed
Apical Microsurgery
4. Healing Complete

Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended or prescribed. If you have pain that does not respond to medication, please call our office.

Are There Any Potential Problems After Treatment?

Lower teeth and nerve injury. There is a slight possibility that nerve injury can occur during root canal surgery to the lower posterior teeth. Your endodontist is trained to assess this possibility prior to treatment and will advise you accordingly. For lower posterior teeth, the root tips may be near a nerve that supplies feeling to the lip, chin and gums. Your endodontist is trained to design your surgery to minimize the chances of damaging this nerve. Rarely, this nerve can become irritated during the process of surgery. In these cases, when the local anesthesia wears off, you may experience tingling, altered sensation or, in rare cases a complete lack of feeling in the affected tissues. Should this occur, it is usually temporary and will resolve over a period of days, weeks or months. In rare cases, these changes can be permanent and/or painful.

Upper teeth and sinus communication. The upper teeth are situated near your sinuses, and root canal surgery can result in a communication between your mouth and the adjacent sinus. Should this complication occur, it will usually heal spontaneously. We will give you special instructions if this is apparent at the time of surgery. We prefer that you don’t blow your nose for two to three days after surgery. If you have to sneeze, you should sneeze with an open mouth into a tissue. You should not create any pressure in the sinus area. If you sense a complication after surgery, please contact us.

Post-operative infections. Post-operative infections occasionally occur. This usually requires just an office visit and examination. Many times placing you on an antibiotic for one week will take care of the infection Occasionally, other follow-up procedures will be needed.

If you have any questions, please call our office.