When a root canal fails it is usually due to one of the following:
Many of the 'failures' can be saved, with the exception of a severely cracked tooth, with a surgical procedure called an apicoectomy. This surgery involves removal of the the root tip or 'apex' of the tooth root. During the procedure, the area around the root tip is also cleaned to remove any infected tissue and cystic formations. Apicoectomy is an in office procedure performed by an Oral and Maxillofacial Surgeon. After healing all infection at the tip of the root should disappear and bone should heal to fill in the area around the root tip.
Your teeth are held in place by roots that extend into your jawbone. During root canal treatment, the canals are cleaned. Inflamed or infected tissue is removed. Sometimes, even after root canal treatment, infected debris can remain in the canal. This can possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.
If a root canal procedure has been done in the past and the tooth becomes infected again, the problem is often located near the apex or tip of the root. Your maxillofacial surgeon can do an apicoectomy to fix the problem so the tooth doesn't need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.
Before the procedure, you will have a consultation with your maxillofacial surgeon which is specialized in that kind of treatment.
Your surgeon may take more x-rays of the tooth and surrounding bone. You may be given a medicine to reduce inflammation and/or antibiotics to treat or prevent infection. Your medical history will be reviewed. The proper anesthetic option wether local anesthesia or local anesthesia in combination to intra-venous sedation will be discussed.
The maxillofacial surgeon will make a small incison in the gum to gain access to the root. The infected tissue will be removed along with the last few millimeters of the root tip. To complete the apicoectomy, the end of the tooth's canal will be cleaned and sealed. Most apicoectomies take 30 to 45 minutes. The length of the procedure will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest while those on lower molars take the longest.
We will tell you which medicines to take and what you can eat or drink. You should apply ice to the area for 10 to 12 hours after the surgery, and rest during that time. The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. To allow for healing, you should avoid brushing the area or rinsing vigourously. Also, don't smoke or eat crunchy and hard foods. Your stitches will dissolve 2 to 7 days after the procedure. All soreness and swelling are usually gone within 14 days. Even though an apicoectomy is considered surgery, many people say that recovering from it is easier than recovering from the original root canal treatment.
The maxillofacial surgeon will review the risks of the procedure at the consultation visit. The main risk is that the surgery may not work and the tooth may need to be extracted. Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses. The roots of the back teeth in the lower jaw are close to some major nerves. Surgery on one of these teeth carries a slight risk of nerve damage. However, your surgeon will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.
An apicoectomy is usually a permanent solution. It should last for the life of the tooth.
If apicoectomy is not indicated or if you prefer not to have the treatment done, the only other option is extraction of the tooth. Replacement of that tooth can then be considered usually with an implant supported tooth which is in most case the best option.