What is Endodontic Microsurgery?
With appropriate care, most endodontically-treated teeth that are properly restored (usually with a core foundation and crown) can last as long as your other natural teeth. In some cases, however, the disease may not heal and might not be detected for months or even years after the initial treatment.
How Does Endodontic Microsurgery Work?
Lack of healing is caused by bacteria that contaminate the previously-treated root canals. Bacterial contamination usually occurs because of a problem that developed after the initial root canal treatment: new tooth decay, a cracked tooth, delay in properly restoring the tooth, or a broken filling.
Bacteria can also contaminate root canals that have very complex anatomy or calcifications that were inadequately treated during the previous root canal treatment.
If your symptoms persist but the cause of the problem cannot be found after x-rays and an examination, your tooth may have a crack or complicated canal anatomy that could not be detected or adequately treated with root canal treatment. In these situations, endodontic microsurgery will give you the best chance to keep a tooth that would otherwise need to be removed. Traditional techniques for apical surgery do not produce predictable healing results. When endodontic surgery is performed by an endodontist trained in microsurgery, healing rates can exceed 90%. If your tooth has not healed after root canal treatment and your dentist says the tooth needs to be removed, ask to see an endodontist trained in microsurgery.
If a crack is discovered during the surgery, more of the root is removed until the crack is no longer present. If the crack extends from the root to the chewing surface of the tooth, either the root or the entire tooth will need to be removed.
After numbing the area, an incision is made in the gum tissues that are then lifted away from the surface of your tooth and the surrounding bone. A small hole is made in the bone to locate the tip of the root which is then carefully cut away until it is a few millimeters shorter. More than 90% of branches of root canals are located within 3 millimeters of the root tip. Removing 3-4 millimeters of the root tip eliminates these root canal branches that contain millions of bacteria. Using special ultrasonic instruments, a few millimeters of the previous root filling material is removed.
Next, the root surface is stained and observed under high magnification using an operating microscope. If no cracks are observed then any previously untreated areas are shaped using ultrasonic instruments and the root canal is disinfected, dried, and filled with a cement-like material. The gum tissues are then replaced and held in their normal position by sutures (stitches). Following successful surgical treatment, bone grows back in the area over the next several months and years.