Sometimes, the best way to surgically retreat a failing root canal treatment is to approach it through the root instead of the crown. This approach is apical surgery or apicoectomy (surgery on the apex, or tip, of the root). Apical surgery may be indicated in the case of persistent, well-established infections or cysts, cases in which retreatment may have undesirable consequences, or infected canal spaces accessible only through surgery.
During apical surgery, the endodontist accesses the infection through an incision in the gums. The infected tissue is removed and sent to a pathology lab to be evaluated. The root’s tip, which usually contains the source of the problem, is also removed. The endodontist then carefully prepares a small tunnel in the root canal and places a root-end filling. The gum tissue is closed with sutures that are removed after several days. Once the infection is removed, the bone can heal.
In the past, it was difficult to predict a successful apicoectomy, but advances in diagnostic and surgical techniques, including microscopic visualization and ultrasonic instrumentation, have dramatically increased surgical precision. As a result, success rates are higher than they ever were before.
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