Service 03

Endodontic Microsurgery.

The word surgery does most of the frightening here. In practice it is a short, precise procedure through a few millimetres of gum, done under a microscope, with a recovery most people describe as easier than the toothache that preceded it.

Illustration of an apicoectomy: the infected root tip is removed and the canal end sealed — The root tip and the infected tissue around it are removed, and the canal is sealed from the end.

What It Is

Treating the root tip from the outside

When infection persists at the very end of a root and cannot be reached through the crown, we reach it the other way.

An apicoectomy — root end surgery — begins with a small opening in the gum beside the tooth. The infected tissue in the bone is removed, the last few millimetres of the root are taken off, and the exposed canal end is cleaned with ultrasonic tips and sealed with a biocompatible filling. The gum is closed with fine sutures and the bone fills back in over the following months.

Crucially, the crown stays untouched. If you have an expensive restoration or a post cemented into the root, microsurgery avoids dismantling any of it.

When microsurgery is the right choice

Infection persists after a technically sound root canal
A post or crown cannot be removed without destroying the tooth
A canal is blocked, ledged or has a separated instrument in it
A cyst or lesion needs to be removed and examined
A root is perforated or has an untreatable lateral canal

Modern microsurgery is a different operation from the apicoectomy of thirty years ago. Smaller openings, ultrasonic preparation and bioceramic seals have raised success rates dramatically.

Recovery

Expect some swelling for two to three days — an ice pack on the first day makes a real difference. Discomfort is usually well controlled with over-the-counter painkillers. Most people take the rest of the day off and return to work the next morning. Sutures come out after about a week, and we check the healing radiographically at six months and again at a year.

~1 hourTypical procedure

1 weekTo suture removal

Crown keptNo restoration removed

Endodontic Services

Dr. Talati's Focus

Surgical re-treatment was a core part of Dr. Talati's residency at the University of Connecticut, where he served as Chief Resident.

Read His Biography

Before You Come In

Keep taking your regular medication unless we tell you otherwise, eat normally beforehand, and arrange for someone to drive you if you are having sedation.

Common Questions

The Procedure

Five steps, about an hour

Planning from the 3D scan

A cone beam scan shows us exactly where the root tip sits, how close it is to the sinus or the nerve canal, and how large the lesion is — before any incision is made.

Anaesthesia and access

The area is fully numbed, then a small flap of gum is lifted to expose the bone over the root tip.

Removing the infection

The inflamed tissue is cleared from the bone and the last three millimetres of root — the portion with most of the complex anatomy — are removed.

Preparing and sealing the canal end

Ultrasonic tips prepare a small, clean cavity in the cut root surface, which is filled with a bioceramic material that seals the canal and encourages bone to heal against it.

Closing

The gum is repositioned and closed with fine sutures. A radiograph confirms the seal, and you go home with written aftercare and a number to call.

Ask whether surgery is really necessary

Sometimes it is. Often non-surgical re-treatment will do, and we will say so.

Request a Consultation About Re-Treatment