Apicoectomy, Surgical Endodontics
Endodontics (root canal therapy) provides a great service for those patients with extensively damaged teeth. With out endodontic care we would be faced with many more dental replacements. Root canal therapy is required when the dental pulp (nerve) has become diseased or infected. The presence of this necrotic (dead) tissue in the canal will result in dental abscesses and pain. With root canal therapy, the pulp is removed through the crown of the tooth, the internal pulp chamber and canal is cleaned, and filled with an inert plastic material (gutter percha). Success is predicated on achieving a hermetic seal to the canal. If successful, the tooth can be salvaged for many years. In spite of this, and for various reasons, routine Endodontics is not always successful. Therefore, surgical endodontics is frequently the next phase of treatment to attempt salvage.
The Endodontist (root canal specialist) is generally trained to perform surgical care but frequently the Oral and Maxillofacial Surgeon is called upon to perform these procedures especially in anatomically difficult areas. Some teeth requiring surgical endodontic salvage are closely positioned adjacent to important structures such as the maxillary (upper jaw) sinus and the inferior alveolar neuro-vascular bundle (lower jaw nerve). The Oral and Maxillofacial surgeon is called upon to treat these areas due to our surgical experience and comfort around these structures, and our abilities to provide safe intravenous anesthetic management and anxiety control.
How is Surgery Performed?
The goal of performing surgical endodontic care is to salvage teeth with previously successful but now failing, or unsuccessful endodontic care. A small incision is placed in the gum tissue over the involved tooth. The apex (end of the tooth root) is surgically approached and a small amount of the apex is removed. The canal is then opened and cleaned and finally resealed, eliminating the nidus of inflammation and / or infection. These procedures can be done with either local anesthesia or under intravenous ultra-light general anesthesia.
Technology has advanced our ability to obtain successful results in highly compromised anatomical situations. The use of ultrasonic apical preparation, glass ionomer filling materials, microscopic equipment, and allogenic bone grafting are some of the routine, leading edge techniques used in our office. With these techniques, surgical endodontics can be highly successful.
Drs. Elias, Stephens and Verratti work closely with many area endodontists and general practice dentists, providing surgical endodontic care for their patients.