When conventional root canal treatment cannot be performed or has not been successful then a surgical root canal procedure may need to be performed. Surgery may be done to check the end of a tooth's root for cracks, remove parts of a root that could not be adequately sealed during conventional root canal treatment, or to clear up an infection that has not healed after conventional treatment.
There are many surgical procedures that your endodontist is trained to perform. The most common procedure is an apicoectomy.
During an apicoectomy the endodontist will drill a hole in the top, or enamel, of your tooth to give access to your root canals and the pulp inside them. The pulp, a soft tissue needed when your tooth is developing but not needed once the tooth is fully grown, will be removed. A substance called gutta-percha will then be used to fill the root canals. A filling may be used to close the hole in your tooth.
The endodontist will then make a small cut in the gum tissue near the tooth. They will use specialized instruments to remove any infected or inflamed tissue and to remove the end of the root. A suture or stitching will be used to close the incision and the tissue and incision will eventually heal over the next several months.
An endodontist is a dentist who has received three years of advanced training in endodontic procedures and has limited their practice to performing only endodontic procedures. Dentists will regularly refer patients needing endodontic procedures to an endodontist because of their experience in dealing with both routine and difficult endodontic procedures. Endodontists are also experts in diagnosing the cause of oral and facial pain.
Most patients report that they are comfortable during endodontic surgery. The local anaesthetics used during endodontic surgery make the procedure relatively painless. After treatment the tooth may be sensitive and you may experience slight discomfort. However, your endodontist will give you instructions regarding which medications will relieve this pain. If you experience severe pain or pain that lasts for longer than a few days contact your endodontist.
Other than practicing proper oral hygiene your tooth should not require any special treatment and should function as well as any other tooth. You may need to make an appointment with your dentist to have a crown or other restoration placed on your tooth. If you do then you cannot use the tooth for chewing or biting until it has been restored.
There are alternatives to endodontic surgery which require the removal of the tooth. The extracted tooth must be replaced with a fixed bridge, implant, or removable partial denture. These procedures are often more time-consuming and will thus be more costly than endodontic treatment and the restoration of the natural tooth. As well, while they are effective, modern tooth replacements are still not as good as having your natural tooth.