Introduction: Surgical Endodontics
Around 8% of patients who undergo root canal therapy will have recurrent infections related to failure of the technique. Surgical Endodontics offers a method of salvaging these teeth and prevention of their extraction.
Surgical Endodontics involves the treatment of infections related to the roots of teeth directly, by raising flaps of gum tissue, cleaning out the area of infection and sealing the root canal from inside the jaw. The procedure frequently involves removal of the apex or apices of multi rooted teeth (apicetomy). The success rate is in the region of 90%. The NCAFOS Clinics advocate that the procedure may be carried out using the operating microscope (microapicectomy) which is though to have a higher success rate of around 99%. The bone may be reconstructed using a synthetic graft material which stimulates the repair of damaged bone.
Who is a candidate for Surgical Endodontics
All patients with failed root canal treatment who have adequate bone around the root of the tooth are suitable for this procedure.
Contraindications for Surgical Endodontics
Patients with a history of rheumatic fever may not be suitable for this procedure. Surgery is contraindicated in patients with a history of infected endocarditis, and should be used with caution in cases of immunosuppression.
is usually carried out under local anaesthetic with intravenous antibiotic
cover. Intravenous sedation is available on request. For teeth at the
back of the mouth - with difficult access general anaesthesia may be
used. A flap of gum is raised the area of infection in the jaw around
the root is cleaned and biopsied. Any dental cyst present is enucleated.
The apex or apices of the affected tooth/teeth are removed and the root
canal cleaned from inside the bony cavity in the jaw. A dental restoration
is packed down the root canal from inside the jaw. The operation is
best carried out using the operating microscope. For lower teeth lying
close to the nerve of sensation of the lower lip, the nerve may be dissected
out of the jaw to preserve the sensation of the lower lip whilst surgery
is carried out on the root tip.
At the end of the operation there is a hole in the bone usually above the root of the tooth. This may be reconstructed using synthetic granules which stimulate new bone formation repair of the area. On some occasions the bone on the lateral sides of the root may have been destroyed. This is an important cause of failure of the operation. In such cases salvage of the root is possible with reconstruction of the bone in this area using a similar technique. The granules are held in place by a resorbable mesh place over the hole underneath the gum in a technique known as guided tissue regeneration
Advantages of Surgical Endodontics
Surgical Endodontics permit the salvage of failed root canal treatment.
Disadvantages of Surgical Endodontics
Surgical Endodontics must be carried out in conjunction with normal root canal therapy for optimum results. It is not advocated for the treatment of a non root treated crowned tooth with an abscess. In such a case the crown requires removal with conventional root canal therapy - holding surgical Endodontics in reserve. Acute infections should be drained first either through the tooth or gum with surgery being carried out when the infection is under control.
Complications involve pain and swelling following the operation sometimes with the development of a black eye when teeth are treated in the upper jaw. In the lower jaw numbness of the lower lip may occur and may be permanent. This is more likely to occur with premolar and molar teeth lying close to the sensory nerve to the lower lip as it travels through the lower jaw.