Endodontic surgery is commonly referred to as apicoectomy. It involves removal of the infected root tip and surrounding inflammed tissue and placement of a root end filling in order to treat and preserve a tooth with a root canal re-infection. This is done in a surgical setting with the aid of a microscope.

After local anaesthetic is given, the gums are raised to expose the tooth and bone. The root and its surrounding structures will be inspected especially for the presence of any cracks or fractures. Curettage will be carried out and diseased tissues removed for biopsy if necessary. The affected root tip is then resected before the apical root canal is sealed with a root end filling.

If the affected root or tooth is deemed beyond surgical repair or treatment, the endodontist may advise to have it extracted instead and this can be done during the surgery on the same day.

Why is endodontic surgery needed?

Root canal treatment aims to eliminate bacteria and disinfect the tooth. Generally, most root canal treated teeth last as long as natural teeth if appropriately restored and regularly maintained. This includes home oral hygiene measures such as brushing and flossing and visits to the dentist for check-ups and scaling.

However, as the structure of the root canal system can be very complex, remaining bacteria may sometimes harbour despite best efforts to clean them out, giving rise to persistent infection later. Sometimes, recurrent decay, cracks or defective restorations can affect the root filling, eventually causing the root canals to be re-infected.

Symptoms that may indicate persistent or recurrent infection include persistent pain and tenderness or swelling of the gums in the area near the tooth despite previous root canal treatment.

  Gum boil or sinus tract

   Sinus tracing of a soft tissue swelling