Root end surgery
The correct scientific term for this procedure is apicoectomy or periapical curettage. It is performed on infections affecting the tip of the tooth root, which cannot be treated endodontically. It can also be performed as a part of the preparation for placing an implant, or in many other cases. Basically, it is a microsurgical procedure, where a tooth’s root tip is removed and a root end cavity is prepared and filled with a biocompatible material, which speeds up the healing process. Root end surgery is performed with the aid of a local anaesthetic and is completely painless. This procedure is very time intensive and takes about one hour and a half. Thanks to the use of a microscope, we are able to identify any potential cracks in the root, which are usually the cause of chronic bone infections. In tandem with root end surgery, we also perform retrograde root canal therapy (removing infected tissue and filling the root canal cavity from the tip upwards)
It is important that the patient receives a dose of analgesics after the procedure before the anaesthetic wears off – it will stop the sudden surge of pain caused by the return of sensitivity to the nerves affected by the local anaesthetic. You can expect temporary swelling of the gums in the area of the tooth after the surgery, which can cause slight discomfort. However, after a few days the swelling and discomfort subside.
The longevity of the tooth after root end surgery can be both short-term and long-term. If the surgery and associated treatment are performed properly and stem from a correct diagnosis, the tooth can remain attached for a period of many years. You cannot, however, expect it to last as long as a healthy tooth would, or as long as a tooth treated non-invasively would.
Root end surgery is most commonly performed on incisors, canine teeth and premolars, rarely on molars. Wherever possible, we prefer the so-called endodontic retreatment of the root canals (repeated root canal treatment), performed through the tooth itself, thus without the need for a surgical procedure. The probability of successful treatment is higher and the longevity of the tooth is longer. We only resort to root end surgery when endodontic retreatment is not possible, or in situations where endodontic treatment has been already performed, yet the infection in the bone persists.