Your Guide to Endodontic Surgery

To understand endodontic surgery, it helps first to know something about the nonsurgical endodontic procedure, or "root canal." A root canal is necessary when the soft inner tissue, or "pulp," of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth or a blow to the tooth. Endodontic treatment removes the damaged pulp. Then the tooth's canals are cleaned and filled to help preserve the tooth.

In a few cases, however, nonsurgical endodontic treatment alone cannot save the tooth. In such a case, your dentist or endodontist may recommend surgery.

Who performs endodontic surgery?

All dentist received training in endodontic treatment in dental school. However, because endodontic surgery can be more challenging than providing nonsurgical treatment, many dentists refer patients needing surgery to endodontists.

Endodontists are dentist with at least two additional years of advanced education and training in root canal techniques and procedures. In addition to treating routine cases, they are experts in performing complicated procedures including surgery. They often treat difficult cases--such as teeth with unusual or complex root structure or small, narrow canals. This special training and experience can be very valuable when endodontic surgery is necessary.

Why would I need endodontic surgery?

Surgery can help save your tooth in a variety of situations.

•	Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the root of your tooth, find the problem and provide treatment.
•	Sometimes calcium deposits make a canal too narrow for the cleaning and shaping instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this "calcification," your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
•	Usually, a tooth that has undergone a root canal can last the rest of life and never need further endodontic treatment. However, in a few cases a tooth may fail to heal. The may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
•	Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.