Do you have a tooth which has already had root canal treatment and is still having issues? This tooth may be a candidate for a ‘root end procedure’ or ‘apical surgery’. St. Lawrence Dentistry has saved many teeth through this very useful technique.
‘Root end procedure’ is actually an umbrella term for 3 separate procedures done in conjunction. These are apical curettage, apicoectomy, and retrofill. These are is simple procedures to treat dental abscesses at the end of a root. They are done on teeth which exclusively have had root canal treatment or are going to have root canal treatment the same day as this procedure.
When a tooth has a dental abscess this means that bacteria are present in the tooth as well as in the bone surrounding the tooth (peri-radicular abscess). In this environment the immune system cannot dissipate the bacteria because there is no blood supply in the tooth (and hence no immune cells). In this scenario bacteria in the tooth replicate and spill in the surrounding bone. A root canal procedure treats the bacteria inside the tooth and corks off the end of the root. This procedure alone is usually enough to allow the bacteria in the bone to dissipate. When the root canal procedure siphons off the root end the immune system usually has the power to control the bacteria in the bone and it begins to dissipate. However, in the minority of circumstances this is not the case and this is when the root end procedures can be effective.
If the bacteria persists at the end of the root despite root canal treatment being performed there are 2 options: redoing the root canal or doing a root end procedure. Root canals retreatment is an ideal choice if there was an obvious deficiency in the root canal done. This could include a missed canal or short root fill. If the initial root canal treatment is already done ideally then usually there is no point in redoing it and going direct to a root end procedure is the most reasonable. One main advantage of a root end procedure over redoing a root canal to address ongoing symptoms is the root end procedure directly removes any bacteria at the end of the root. On the other hand, redoing a root canal will only create an environment in which the bacteria may begin to dissipate. This should be factored in when deciding what treatment to do. Dr. Hawryluk will go over the best option in your specific case.
The first step in performing a root end procedure is gently pushing back the gingiva (gum) in the area of the abscess. Often times when the bone is exposed the dentist will see a tiny opening leading to the dental abscess thru the bone. Magnification is key and the procedure should not be attempted without the use of a high resolution dental microscope. One the abscess area is found the thin veneer of bone around the abscess is gently trephined away until it is completely exposed. Apical curettage is then done which is the removal of all the abscess tissue. It generally looks like a gelatinous tissue which is easy to spot with the microscope. The part of the root which has been bathing in the abscess tissue it trimmed (apicoectomy) and then the remainder of the root end is packed with filling material (retrofill). The end of the root is prepared for the retrofill by using ultrasonic instruments. Dr. Hawryluk Jr. uses the Satelec P5 Newton unit with special retero preparation tips for this process. The end of the root is packed with a substance called MTA or IRM which research has found are the most effective retrofill materials.
Root end procedures are a very valuable technique as it saves teeth which would have otherwise been removed. Although the procedure is technique sensitive and advanced equipment is needed, it is relatively simple procedure and usually has a comfortable subsequent recovery. If you would like to learn more about this technique and live in the Mississauga/Toronto area St. Lawrence Dentistry.