West Jersey Oral & Maxillofacial Surgeons. P.C.

Root canal treatment is performed routinely to relieve dental pain due to infection and necrosis of the dental pulp (nerves and blood vessels within the tooth). In the majority of cases root canal treatment is very successful extending the life of the tooth for many years. However, there are certain instances when root canal treated teeth will be come infected and symptomatic.

There are several ways for pain and infection to occur in a root canal treated tooth. The internal anatomy of the root canal system of a tooth has some variability that makes it difficult to perform an ideal root canal treatment. Roots with accessory (extra) root canals and lateral canals, severely curved roots, and internal calcifications provide the dentist performing the root canal treatment with a great challenge.

In addition, many root canal treated teeth are restored with crowns. The crowns provide protection for the weakened tooth and also restores the tooth form and function. Unfortunately, the area where the crown meets the natural tooth structure margin is always imperfect microscopically. Over time the cement used to secure the crown to the tooth dissipates and allows for microleakage of plaque and bacteria under the crown. The bacteria slowly infect the root canal treated tooth resulting in pain and swelling localized around the apex (tip of the root). It is not uncommon for a small fistula to form in the gum over the apex of the root enabling spontaneous drainage. This will typically result in the resolution of symptoms, but does not cure the underlying problem.

A small number of root canal treated teeth will develop vertical root fractures rendering them none restorable. The problem with root fractures is that they are often not visible to the naked eye and are not visualized on routine dental x-rays.

Surgical endodontic treatment (apicoectomy) is routinely performed on failing root canal treated teeth. The procedure is often done with local anesthesia with or without IV anesthesia. A small incision is made in the gum adjacent to the tooth and the gum is retracted exposing the jawbone. A small amount of bone is removed overlying the root tip and the infected tooth root apex is exposed. The surrounding infection is removed and the tip of the root is removed (approximately 2 – 3 mm). Dr. Sansevere wears special magnifying glasses and a headlight to enlarge and illuminate the visual field. The root canals are identified and prepared with an ultrasonic diamond tip instrument. A root end filling (retrograde filling) is delivered in to the preparation. The surgical site is closed with resorbing (dissolving) sutures.

The recovery period after apicoectomy varies from patient to patient. Most patients can return to work in one or two days. Strenuous physical activity and exercise may be resumed in 3 to 4 days as tolerated.