Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and your endodontist will recommend surgery. This involves making an incision in the gingiva to allow access to the end of the root(s). Endodontic surgery may be recommended in conjunction with a retreatment or as an alternative.
There are various surgical procedures that can be performed to save a tooth, the most common is called Apicoectomy. An apicoectomy is indicated when there is damage to root surfaces or the surrounding bone of the tooth, or when calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of your root, or when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.
In this microsurgical procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.
A small filling is placed to seal the end of the root canal and few stitches or sutures are placed to help the gum tissue heal.
Over a period of months, the bone heals around the end of the root. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Postsurgical discomfort is generally mild.