Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and your endodontist will recommend surgery. Endodontic microsurgery can be used to access and clean areas of the tooth and surrounding bone that were not negotiable during previous treatment resulting in persistent inflammation or infection. The most common surgical procedure is called an apicoectomy, or root-end resection.
In this microsurgical procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling is placed in the end of the root canal and the area is closed with a few sutures (stitches). Over a period of months, the bone reforms around the end of the root. Local anesthetics make the procedure comfortable, and most patients return to their normal activities the next day. Post-surgical discomfort is generally mild and manageable with over-the-counter aids.