Occasionally, an infection can persist or reemerge after you have undergone root canal therapy. When this happens, retreatment of the root canal might become necessary. If that approach is unable to completely and fully eradicate the infection, root canal surgery can resolve the issue. An apical microsurgery (sometimes called an apicoectomy, a root resection, or a root-end filling) is a procedure in which the endodontist removes the problematic, infected root tips and surrounding tissue entirely.
How Root Canals Work
A root canal is a relatively straightforward treatment program designed to repair and save severely infected or damaged teeth. This is often a preferred alternative to simply pulling the tooth.. The nomenclature “root canal” is derived from the component of the tooth’s anatomy that demands medical care – the canals within the tooth’s root.
Teeth are comprised of several parts, including a soft core called dental pulp. The dental pulp extends from the visible crown of the tooth all the way to the tip of its root, which is embedded into the jawbone. This pulp contains nerves, blood vessels, and connective tissue. If a tooth is badly broken or suffers from a sufficiently deep cavity, bacteria can infiltrate the pulp. If left untreated, the bacteria and decaying material can lead to infection and tooth abscess, which in turn causes pulp death, bone loss, and even the loss of the tooth itself.
After taking an x-ray to confirm the extent of the damage, your endodontist can get to work. The endodontist removes decay and opens the tooth’s crown (the part of the tooth visible in the mouth) to access the pulp chamber. Using extremely small dental instruments, he or she manually removes the infected or diseased dental pulp. Afterwards, the pulp chamber and root canals are flushed, cleaned, and dried. If necessary, the dentist or endodontist can also inject medication into the pulp chamber and root canals to help eradicate infection. Once the cleaning and drying processes are complete, the canals are filling with a rubber filling material called gutta percha, as well as a temporary dental filling to further protect the root canals from saliva. The final step is tooth restoration, usually accomplished by placing a crown or final filling with your general dentist.
You Can Get An Infection After A Root Canal
It is important to fully appreciate how unique every root canal treatment program is. Your endodontist or general dentist is deeply invested in completely resolving any instances of infection, regardless of its severity. As such, root canal therapy can require multiple visits. A temporary filling is often employed to protect the tooth from debris and saliva between trips to the patient’s chair.
However, it is very important to remain vigilant – even as a patient – to protect against the several reasons that a root canal can fail:
- If even a small amount of bacteria remains in the canals of the tooth’s roots, it is possible for it to multiply and the infection to re-emerge.
- If your tooth has an uncommonly vast network of canals for its specific type, sometimes it is physically impossible to fill them all. This un-cleaned, unfilled canal space could now be home to a rapidly growing infection all over again, which would require apical surgery after the traditional root canal has been completed.
- Sometimes, endodontists discover canals that were missed during the initial treatment.
- Temporary or improperly placed fillings sometimes break down or leak, which creates opportunities for bacteria to recontaminate vulnerable areas in the canal. Similarly, an undetected crack in the root of a tooth is an open invitation to new or continued infection.
- New trauma to the tooth can lead to reinfection.
How Patients Can Manage Infection After A Root Canal
Re-treatment (a repeat root canal procedure) is sometimes a suitable solution for reinfection of the tooth. However, these are typically more involved and complicated endeavors than the first time around. The tooth is opened back up through the crown and the root canals are recleaned, canals that were missed or inadequately filled are addressed, and the tooth is permanently closed by your general dentist. It is sometimes too risky for the safety of the tooth to attempt a retreatment. When that risk is considerable, endodontic surgery is likely the best bet to save the tooth.
Rather than accessing the canals that need to be cleaned through an entrance at the “top of the tooth” or the crown, endodontic surgery allows us to enter the inside of a tooth “from the bottom,” at its roots. Via a small incision in the gums near the tooth’s base, the endodontist cleans the infected tissue near the apex of the root and simply shaves off its problematic tips to gain interior access. He or she can then clean the inside of the canal from the root end, fill it in, and suture the incision in the gum tissue closed. An apicoectomy is appropriate only after a tooth has undergone at least one root canal procedure.
Struggling with dental health issues can be a challenge, which is why it is critical to maintain an open line of communication with your dentist or endodontist. Together, you are certain to identify and execute the proper strategy for you achieve permanent relief and a healthier, happier smile.
About the Author
Dr. Harris has been a practicing dentist and oral surgeon since 2005. In 2012, he received his Master’s of Science in Dentistry and a certificate in Endodontics. He founded East Coast Endodontics shortly after receiving his master’s degree. He also currently holds a part-time position as a Clinical Assistant Professor for the Endodontics department at Virginia Commonwealth University. View his full bio.