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 apicoectomy or root-end resection.

What is an Apicoectomy?

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. The bone naturally heals around the root over a period of months restoring full function.

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. If you have pain that does not respond to medication, please call our office.

Are There Any Potential Problems After Complex Endodontic Surgery?

  • 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.

Post operative instructions after APICOECTOMY:

1. Take prescribed medications as directed. If tolerated, over-the-counter anti-inflammatory medications such as Ibuprofen (Advil, Motrin, and Aleve) can be taken as needed to relieve discomfort. NEVER MIX PAIN MEDICATION & ALCOHOL.

2. To minimize swelling, apply a cold compress to the outside of the face directly over the surgical area. Cold beverages, ice cream, or ice chips will also add to comfort. Do not apply heat to the area.

3. Expect some oozing (slight bleeding, reddish colored saliva) to occur for several hours after surgery. Should excessive bleeding occur place a moistened tea bag on the area for a full 30 minutes, if bleedings has not stopped call the office immediately.

4. There may be slight swelling and discoloration in the area for 3-5 days following the surgery, this is a normal part of the healing process.

5. In some cases there may be temporary loss of feeling in the operated area. The treated tooth may feel loose or sensitive-this should dissipate over time.

6. Do not brush teeth in surgical area for 72 hours, then only light, gentle brushing for the next 3-4 days (you may brush all other areas as normal). After the 1st 24 hours, you will need to use the Peridex rinse in place of brushing.

7. Do not rinse or spit for the first 24 hours. Starting tomorrow, warm salt-water rinses (1 tsp. salt to 1-cup water) can reduce discomfort and aid in healing.

8. Maintain a soft food diet the first 24 hours then avoid chewing in the area for the next few days.

9. To minimize post operative problems do not lift the lip to examine the area (this can tear sutures).