Endodontic Surgery

Endodontic Surgery - What it is

Why do I need Endodontic Surgery?

Endodontic surgery is recommended

When the root canal treated tooth did not heal despite adequate treatment
When conventional non-surgical retreatment is not recommended
In conjunction with conventional root canal retreatment
To explore cracks or possible fractures on the root
To perform biopsies and remove cysts or growths

Before Surgery: Radiograph of cyst	After Surgery: Radiograph of large post

Why do some root canal treated teeth fail?

Root canal treatment aims to eliminate bacteria and disinfect the tooth. However, as the root canal system is very complex, complete removal of bacteria may not always be possible. Accessory canals, especially at the root apices, could allow bacteria to persist despite best efforts to clean them out, giving rise to persistent infection.

Decay, cracks or defective fillings and crowns may allow bacteria to penetrate the root canal filling, eventually causing the root canals to be re-infected.

Some cysts at the root may not heal with root canal treatment alone.

What does it involve?

Endodontic surgery is usually performed under local anaesthesia. If the case is complex, general anaesthesia may be indicated. This procedure is performed with the aid of an operating microscope.
The gums are lifted to expose the bone and tooth beneath.
The root and its surrounding area will be inspected especially for any cracks or fractures.
Diseased tissues are removed and may be sent for a biopsy.
The affected root tip is removed and cleaning and filling of the root canal be performed from the end of the root.
The gums are stitched back.

Endodontic Surgery - Causes and Risk Factors

If the affected root or tooth is deemed to be beyond surgical repair or treatment, it may be extracted during the same surgery.
If the affected tooth and area is in close proximity to important anatomical structures, there may be a minor risk for complications such as sinus floor perforations or nerve damage.
Other risks include potential infection, side effects to the medications used or the general/local anaesthetic used.

Endodontic Surgery - Preparing for surgery

There is no need to fast prior to the surgery. It would be good to have a light meal instead, especially if you are diabetic.

If you have any pre-existing medical conditions, such as recent heart surgery or uncontrolled diabetes, your dentist may advise you to check with your medical doctor whether you are fit for the surgery.

As the surgery is done under local anaesthesia, generally minimal discomfort is experienced during the surgery.

Endodontic Surgery - Post-surgery care

There may be mild oozing or bleeding from the operation site after surgery.
Some pain, tenderness, swelling, bruising of the operation area may be experienced.
Painkillers and antiseptic mouthrinse will be prescribed, antibiotics may be prescribed where indicated by the doctor.
Stitches will be removed in 5 to 7 days.
Follow up appointments will be scheduled to review the healing of the tooth.
Endodontic surgery has success rates ranging between 80 to 95%. If the tooth does not heal after the surgery, re-surgery may be indicated, or extraction may be advised.

Overview

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Naproxen Sodium

Article contributed by Endodontics, Department of Restorative Dentistry, National Dental Centre Singapore

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