A non-surgical root canal treatment alone may sometimes be inadequate to save your tooth. In such cases, your endodontist may recommend a surgical treatment. 

What Are the Instances That Require Endodontic Surgery? 

For further diagnostic purposes. Sometimes, exploratory surgery may be indicated to locate cracks or possible fractures that could not be detected during non-surgical treatment. During the surgery, your endodontist will be able to examine the surface of the root to arrive at a diagnosis and provide appropriate treatment. 

Non-healing disease. Occasionally, despite adequate non-surgical treatment, a tooth may not heal or have persistent symptoms. The reason for the teeth not responding to previous root canal treatment could be that there are bacteria inside the root or around the root tip that cannot be eradicated by root canal cleaning. And hence, your endodontist may recommend a surgical approach to increase the possibility of saving your tooth. 

When non-surgical retreatment is not possible. In cases where extensive restorative work, such as a large post in the canal, has been done, non-surgical root canal retreatment may be more damaging. A surgical treatment can be a better alternative to save your tooth. 

Remove cysts and perform biopsies. Surgical treatment will be recommended in cases suspicious of a cyst. A cyst can be more sinister than inflamed tissues. The suspected cyst tissue that is removed during surgery will be sent to a laboratory for histological reporting. 

There are other less common scenarios whereby a surgical procedure may be indicated, such as repair of a damaged tooth due to resorption (tooth eaten up by its own cells) or perforation (cavity unintentionally created by a dentist).

What Is an Endodontic Surgery? 

Endodontic surgery is a day surgery typically performed under local anaesthesia. The most common endodontic surgery is an apicoectomy. In this procedure, the endodontist will lift the gum to expose the underlying bone and remove any diseased tissue. This tissue may be sent for biopsy. The end of the root will then be trimmed off, and a small filling will be placed to seal the end of the root canal. Stitches will be placed on the gum to help the tissue heal. 

There are other types of surgical procedures that can be performed, such as removal of a root, repairing damaged root surfaces or even removing the tooth and replanting it back in its socket after performing the endodontic procedure outside of the mouth. Depending on your case, your endodontist will be able to recommend the appropriate surgical treatment. 

What Precautions Do I Need to Take for the Surgery? 

If you’re medically fit, no special precautions will be required prior to the surgery unless otherwise mentioned by your endodontist. 

However, please inform your endodontist if you have any medical illness (e.g., bleeding or clotting disorders), are taking any drugs (e.g., blood thinners), or have drug allergies. 

What Are the Risks and Complications of Endodontic Surgery?

If the surgery is performed near other vital anatomical structures, there is a risk of injuring these vital structures. The injury to the sinus perforation may result in sinusitis. There may be cases of nerve injury that can result in transient numbness. These risks should be discussed with your endodontist prior to your surgery. 

What to Expect After Endodontic Surgery?

Slight bleeding is expected immediately after surgery. Pain, swelling, and bruising will also be experienced around the operated site. After the swelling subsides, there may be a bruise-like mark on the face near the operated site that will recede. 

Painkillers are prescribed to alleviate the pain and swelling. Because we advise against brushing around the wound site, we prescribe an antiseptic mouth rinse for the patient to maintain oral hygiene. Antibiotics are commonly prescribed to prevent secondary infection of the wound site. Gauzes are also given to the patient to stop the bleeding at the wound site. 

Stitches will be removed in 5-7 days. Review appointments will be scheduled to monitor healing. 

For more information on post-operative care instructions, you may refer to the post-operative advice after endodontic surgery.

Oftentimes, the only viable alternative to surgery is the extraction of the tooth. You may then opt for an implant, bridge, or removable partial denture to replace the extracted tooth. Choosing not to replace the missing tooth is also possible, but may result in a decrease in chewing function or shifting of adjacent teeth.  

You may also choose to defer any treatment, but this could lead to potential pain and further loss of surrounding bone, which may compromise future treatment.