SURGICAL ROOT CANAL

(APICOECTOMY/RETROGRADE FILLING)

Patients scheduled to have surgical root canal treatment (apicoectomy/retrograde filling) should be familiar with certain information.  If there are further questions please do not hesitate to ask.

• WHAT IS SURGICAL ROOT CANAL TREATMENT (APICOECTOMY/RETROGRADE FILLING)?  An apicoectomy is the excision of the apical portion of a tooth root through an opening made in the overlying bone.  A retrograde filling is preformed when an apical preparation is followed by a retrograde filling with MTA (Mineral trioxide aggregate) root canal sealer.
• WHEN IS SURGICAL ROOT CANAL TREATMENT (APICOECTOMY/FILLING INDICATED?  When conventional root canal treatment fails to keep a tooth healthy and symptom free, then surgical root canal treatment may be indicated to save the tooth.  These are basically three reasons for failure of conventional root canal treatment.  These include the following:  1.  Accessory root canal system (miniature canals that contain necrotic (dead) material that cannot be reached with conventional root canal treatment.  2.  A poor apical seal “leaking”.  3.  A vertical fracture in the root.  The apicoectomy removes the accessory root canal systems that contain necrotic (dead) material.  If there is a poor apical seal, this can be treated with the retrograde MTA.  If there is a vertical fracture in the root, then the tooth becomes non-restorable and must be extracted.
• HOW IS THIS SURGERY PERFORMED?  An incision is made through the gum tissue close to the apical portion of the involved tooth.  After the bone is exposed, a rotary drill instrument will be used to remove bone and expose the end of the root.  The end of the root will be amputated and all adjacent infected tissue will be cleaned out.  A retrograde MTA filling will now be placed if it is indicated (if there is a poor seal at the root end).