If a root canal fails, then what is the next step for treatment? Root canals need a significant ratio of the tooth to be saved. When vertical tooth fractures and other forms of decay impact the tooth so severely that it cannot be repaired, surgery is often required to advance the treatment process. The dentist will often recommend tooth extractions to completely remove all aspects of the tooth’s decay and infection. Still, for endodontists, we have plenty more techniques at our disposal to correct improper root canal treatments and maintain the tooth’s natural structure. That’s where endodontic surgery and apicoectomies come in.
What is Endodontic Surgery?
Endodontic surgery is commonly referred to due to the long-term treatment plans offered; these measures require maintaining the tooth’s health. However, for those wishing to resolve tooth pain and have more conservative treatment options, endodontic surgery works to locate small, hidden fractures within the tooth’s endometrium and resolve complex pulp conditions, dentin, root canal channels, and apex.
Often, for patients with a tooth pain that can’t be detected firsthand, endodontists work with x-rays. For patients who either had a failed root canal treatment or cannot qualify for a root canal procedure, endodontists work with tooth trauma that’s hidden beneath the surface to remove early signs of tooth pulp infection and internal decay. Endodontic surgery in these cases works with digital imaging, operating microscopes, and other various tools to provide patients with additional restorative options that can treat various conditions, including:
- Cracks that appear microscopic within the root channels
- Cysts that reappear underneath the gum line even after treatment
- Root apex tips blocked by calcium deposits
- Abnormal root channel formations that cause nerve damage
- The damaged and necrotic pulp that spreads throughout the root channels
Endodontists can diagnose many of these issues due to their extensive education in the endometrium and practice using techniques to correct these conditions. Endodontic surgery has the ability to correct these issues and also help patients by bringing advanced techniques forward to preserve the inner tooth and provide substantial, long-term relief from chronic tooth pain and reoccurring tooth infections.
But what constitutes an endodontic procedure? Endodontists often have many techniques they can use to treat tooth pain besides root canals. This list of procedures includes:
- Calcium Removal: The root canal can be blocked by calcium deposits, which can cause severe tooth pain. In these cases, an endodontist can perform a calcium removal procedure to remove these deposits.
- Endodontic Retreatment: In cases where reinfection occurs, your endodontist will remove the previous crown and material, clean the infected root canals, repackage the root channels, and replace the crown.
- Pulpotomy: Endodontists perform pulpotomies to remove the pulp in the tooth crown, leaving the pulp in the root channels intact, and is often performed for children’s primary teeth.
- Pulpectomies: Endodontists also perform pulpectomies to completely remove the pulp from both the crown and the root canal and perform for children’s primary teeth.
- Dental Implants: If endodontic surgery cannot be provided, tooth extraction is performed and then replaced with a dental implant.
In this discussion of endodontic surgeries, apicoectomies are performed as a next step when root canal procedures fail to provide patients with the relief they need.
What Is An Apicoectomy Procedure?
An apicoectomy is an advanced version of a root canal procedure with some extra steps in place. An apicoectomy works to remove the infected pulp from the apex or tips of the tooth and help heal the tips by re-sectioning them back into place. The apex is the tooth’s root tips that connect to the jawbone and features many of the blood vessels, nerves, and lymph vessels that allow blood to enter the pulp. When this area is obstructed or damaged, the endometrium becomes highly vulnerable to pain and other various sensations. Because the apex is a vital part of the tooth’s ability to connect to the jawbone and gums, these infections and blockages can cause the entire tooth to die off within months and years if not treated.
Apicoectomies can also work within the underlying jawbone to remove areas of infection. However, once these areas are clear of infection, materials such as bio-degradable sealants and cement promote the body’s healing process and osseointegration. These surgical procedures work beyond the crown area and main channels to promote better pain relief for patients, and this microscopic procedure can ultimately help patients maintain better oral health and tooth conservation.
Who Qualifies For An Apicoectomy?
For endodontists, the best way to determine candidacy for this procedure involves taking a deeper look into the affected tooth’s internal channels through x-rays, digital imaging, and microscopes to outline the type of infection present, how deep-set it is within the tooth, and the overall integrity of the tooth in comparison to the damaged received.
Often, these various conditions generally qualify for an apicoectomy when diagnosed by an endodontist:
- Apical Periodontitis – Inflammation of the periodontium, or gum tissue area, that’s sourced from an infected pulp at the apex of the tooth will often require an apicoectomy when the pulp infection has spread so severely that it’s begun to seep into the jawbone material.
- Irreversible Pulpitis – Inflammation of the inner pulp that causes apical periodontitis conditions will require apicoectomies if the infection is at its chronic stages.
- Advanced Pulp Necrosis – Pulp tissue dying within the apex can lead to severe infection that spreads throughout the jawbone will often require an apicoectomy to treat.
- Failed Root Canal Treatments – If all of the above conditions don’t resolve with a root canal treatment, then an apicoectomy is necessary.
Apicoectomies often are performed when a root canal procedure failed to correct the issue. Other conditions, such as overall poor tooth integrity and severe signs of decay, won’t qualify a person for this procedure. Your endodontist, in this case, will recommend tooth extraction and a restorative procedure to maintain your oral health.
Please visit or call your primary dentists or endodontist to schedule an appointment for more information about what endodontic procedures may work best for you.
