Performing apicoectomy is required only after an unsuccessful root canal. When an infection does not go away or returns after a root canal, this procedure is usually necessary. Many nerves may contain the infected tissue, so it is essential to remove all of the infection during a root canal. During an apicoectomy, the tip of the root of the tooth is removed and replaced with a filling.

In most cases, a second root canal is considered before an apicoectomy since it is a more straightforward, less invasive procedure. Before the apicoectomy begins, you will be given a local anesthetic to numb the area. The doctor will start by making an incision in your gum to expose the root of your tooth. Any inflamed tissue will be removed to clean out the area. The surgery takes place in a tiny area and removing a few millimeters from the root.

For this reason, the doctor will use magnification and small precision instruments to perform the surgery. The precise nature of the operation gives it a high rate of success. Fitting the tooth with a filling and suturing the gums is done after removing the root. Depending on the type of sutures you may have to return in a few days to have them removed, or dissolving sutures may be used instead. Over the next few months, the bone will heal around the root.

The use of the Endo Microscope allows a doctor to perform procedures with greater accuracy by magnifying the treatment area. The microscope’s superior illumination and magnification have made the most significant impact on visualization of the area, evaluation of surgical technique, and use of fewer x-rays. With the unique ultrasonic unit and tips, a separated instrument or silver point can be removed with less effort. Fourth canals are now routinely being located and completely debrided in virtually all molars, thus increasing the long-term success rate with root canal therapy

Why do I need retreatment?

As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:

• Narrow or curved canals were not treated during the initial procedure.
• Complicated canal anatomy went undetected in the first procedure.
• Delaying the placement of the crown or other restoration following the endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.

In other cases, a new problem can jeopardize a tooth that was successfully treated.

For example:

• New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
• A loose, cracked or broken crown or filling can expose the tooth to a new infection.
• A tooth sustains a fracture.

Retreatment is performed in two visits and involves the following:

At the initial visit, the endodontist will examine the tooth, take x-rays, and discuss your treatment options. If you and your endodontist choose retreatment, the retreatment will be scheduled at that time for a future date. At the retreatment appointment, the endodontist will administer local anesthetic to numb the tooth. After the tooth is numb, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials (crown, post, and core material) must be disassembled and removed to permit access to the root canals.

After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using a microscope, searching for any additional canals or unusual anatomy that requires treatment.
After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. Post space may also be prepared at this time.

After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to full function.
If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery.