Apicoectomy/Surgical Root Canal
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An apicoectomy or surgical root canal retreatment is a procedure that is performed only after traditional root canal therapy has failed. The procedure becomes necessary when inflammation and infection persist at the tip of the root of a tooth after a root canal has been performed or retreated traditionally. Sometimes the infection is present without pain.
X-rays usually show an unresolved, black shadow at the tip of the root of a tooth long after the initial root canal was performed. Sometimes a fistula (or pimple on the gum) might be present, which is a sign of pus and infection draining from the tooth. Swelling and pain in the gum may also be present, or there may be no symptoms at all.
The goal of the procedure is to remove the root tip (apex) of the tooth and the surrounding infected tissue.
After anesthesia, the gum is lifted away from the tooth so the root is easily accessible. The infected tissue, and sometimes a cyst is removed along with the last few millimeters of the root tip. A small filling is placed into each root canal to seal the end of the root. Without proper sealing of all the canals present in the tooth, the apicoectomy will not be successful. Occasionally the defect that is left after apicoectomy may require bone grafting for repair. The gum is then re-positioned and a few sutures (stitches) are placed in the gum tissue to ensure proper healing. In a few months, the bone around the tooth heals and symptoms are gone.