Root canal surgery (also know as apicoectomy, root-end resection, periapical surgery) is sometimes necessary when a tooth remains symptomatic, or proper healing doesn’t occur. Some teeth are not good candidates for retreatment, and are instead treated surgically. This procedure is a “reverse” root canal, when treatment addresses the end of the roots instead of the top of the tooth. Many times it is not possible to reach the infection because of calcification or constriction of the root canal space, previous root canal filling, or type of permanent restoration. Dr. Loth may utilize this procedure to avoid damage to an existing restoration, or to locate fractures, hidden canals, or persistent infections that are not visible on radiographs.

This procedure is performed with local anesthetic, and takes about as long as a conventional non-surgical root canal. An incision is made in the gum tissue beneath the tooth to expose the root tip area. The infected tissue is removed and special retrograde fillings are placed to seal the root canal space. Sutures are then placed to stabilize the gum tissue for a few days until healing takes place. The soft gum tissues heal within a few days, and bone regenerates to heal the defect where the infection was. This will be confirmed with a follow up visit several months later. This is a very predictable treatment, and most patients tolerate it quite well.

Other surgical procedures performed in this office include root amputation, hemisection, and intentional replantation.

Post Operative Instructions

Please take pain medication when you arrive home, as it is easier to prevent pain than to stop pain once it has started. If the medication prescribed doesn’t help or you have an adverse reaction, please contact our office so that we may alter the medication as necessary.

Swelling, minor pain, slight bleeding, and/or skin discoloration may be experienced but should start to subside after a few days. If surgery was performed in the lower jaw, tingling of the lower lip is possible due to stretching the nerve supplying this area.

To keep swelling to a minimum, use a cold compress on your face over the surgical site and keep your head elevated for the first two nights after surgery. The cold compress will constrict blood flow slightly, and should be used alternately 20 minutes on and off for up to 48 hours after surgery. This will prevent swelling, reduce bruising, and relieve temporary throbbing and aching. If the swelling or bruising appears to worsen after 2-3 days, resume the cold compresses and contact our office. Do not pull your lip with your fingers to inspect the area, as this may dislodge the sutures or cause additional swelling.

Get plenty of rest and ensure normal intake of foods and liquids. Avoid smoking and alcohol, and hot, chewy, or hard foods for a couple of days. Brush your teeth, but avoid the surgical site for 24 hours. The incision will heal very quickly, but the gum tissue can swell further and bruise if it is reinjured.

Gently rinse your mouth with tap water the first day of the surgery. After about 24 hours, switch to warm salt rinses or your prescription mouthrinse and continue for a couple of days.

An appointment will be made for you to come back to our office in about 1 week for post operative evaluation and suture removal.