Surgical Endodontics

Surgical Endodontic Treatment
Surgical Endodontic treatment is performed when inflammation or infection persists in the bony area around the end of the root after conventional endodontic treatment. It is performed when there is no other way to access the area because of blockages in the canal, or when we need to visually inspect and treat the end of the root.

Example: Maxillary (Upper) Incisor - Cross section view Before Surgery

Benefits: The tooth is retained, resulting in a more healthy oral condition. Eliminates the need for more expensive prosthetic (artificial) replacement Can prevent Disassembly of existing restoration and need for remake of crowns or bridges. Surgical TreatmentSurgical Endodontic treatment can be performed on any tooth as long as the tooth is periodontally sound (the gum condition is healthy) and restorable (there is enough remaining healthy tooth structure to warrant reconstruction of the tooth). How Long Will it Take?Treatment is generally performed in a single appointment of approximately 90 minutes. Diagnosis/Pretreatment Diagnostic procedures consist of multiple films ( taken at different angles to better locate and visualize the roots), examination of the periodontal tissues and evaluation of suitability of the tooth for treatment. The existing restoration will be examined and alternatives to surgery will be explained in detail.

Surgical Access and Apicoectomy  With the use of modern anesthetics, endodontic surgery involves very little discomfort. An incision is made and the gum tissue is retracted. This allows for good visualization of the surgical area. Any inflamed or infected tissue is removed. If there is sufficient material, a specimen will be sent to laboratory for analysis (Biopsy). The tip of the root is then resected (removed). This is called an Apicoectomy. Sealing of the Apex The end of the root is meticulously examined and a small cement filling(s) may be placed to seal the end of the root canal. A few stitches are placed in the gum to help the tissue heal properly.

Surgical Access and Apicoectomy

Example: Maxillary (Upper) Incisor - Cross section view Root Filling in Place

Post Operative InstructionsIn most situations, post-operative discomfort is minimal. Patients are given a specific set of instructions regarding surgical post-operative care. This mostly involves icing the area and mild analgesics. We generally recommend that you rest for remaining portion of the day. The stitches are removed within a few days. Recall ExaminationPatients are recalled at 6 month intervals to examine for proper healing. CostThe cost of endodontic surgery varies according to the severity of the problem, the location of the tooth and the number of fillings placed at the root end. Dr. Kaufmann recommends a consultation appointment in order to provide you with an estimate. Insurance plans generally cover surgical treatment to the same extent as conventional endodontics. As with any insurance plan, it is a good idea to have a preauthorization performed before the procedure.

Prognosis The rate of success for surgical treatment varies with the tooth, position in the mouth, periodontal condition, previous treatment and other factors particular to the case. Dr. Kaufmann will address the prognosis during your consultation appointment. Sometimes surgery exposes an impossible treatment situation. This is most often the case with Vertical Root Fractures or Split Tooth. Extraction is often necessary in that case. Alternatives to Surgery Extraction of the tooth and prosthetic (artificial) replacement is the usual alternative. Unfortunately, this can often be more expensive and difficult than surgical treatment. Even with bridgework or an implant, there is no true substitute for your own tooth. That is why surgery may be a better option in many cases.  After Your Surgery

Healed surgery