Root End Surgery
Although root canal therapy has a very high degree of success, occasionally, a tooth, which has had root canal therapy, may require retreatment, surgery, or even extraction. Healing is a biologic process and cannot be guaranteed. Like any tooth, root canal treated teeth can still be subject to decay, gum disease, cracks and fractures, and wearing out of the fillings or crown.
Sometimes there is infection on the surface of the root end in the form of a biofilm, which is not accessible through conventional root canal treatment. Surgery allows us to shorten the root tip to remove that biofilm and get a nice clean surface. Surgery also allows us direct visualization of the root to inspect for cracks, fractures, perforations, untreated canals, etc. Finally, surgery allows us to remove inflammatory tissue at the root end or cysts that form at the root end, allowing the bone to fill back in around the root tip.
The video below from the American Association of Endodontists explains this simple procedure. A small incision is made in the gum tissue around the tooth. We shorten the infected root tip to get a nice clean surface and eliminate complex anatomy which can be hard to disinfect in non-surgical root canal treatment. We remove inflamed tissue around the root end and then place a small filling at the tip of the root canal. Bone grafting and guided tissue regeneration may also be recommended. Several sutures are placed to close the incision.
The area will be sore the first few days, and there is a chance of swelling or bruising, so we recommend not to schedule root end surgery right before some other big event like a wedding or family reunion, etc. You want to give yourself time to recover if there is swelling or bruising. We will see you back the next week to remove sutures, and then for periodic checks of healing of the gums and bone.