THURSDAY, FEB.3, 2000
Dear Dr. Mady: I had a root canal done on one of my teeth 2 years ago due to an infected nerve. I have still been experiencing infections off and on since and now my dentist thinks that I should be referred to a specialist for a procedure called an apicoectomy. Why do you think this is happening and what is this procedure all about?-Wally in Belle River.
Dear Wally: It is not unheard of for this to occur after root canal treatment. Sometimes it occurs immediately or it may begin years later. Before I can explain why this is happening and what an apicoectomy is, it is imperative that you understand the non-surgical portion of endodontic (root canal) therapy.
The original reason that you needed root canal treatment is most likely because of severe inflammation or infection of the pulp of your tooth. The pulp is the inner tissue inside of your tooth’s root that is made up mostly of nerve fibers and blood. When this tissue becomes damaged, it must be removed and replaced with a rubber-like filling material to stop the entrance of more bacteria through the root’s apex (opening at end of the root). If more bacteria is allowed to enter, recurrent infections and damage are unavoidable.
Sometimes, a root canal alone is not going to solve the problem completely and your dentist may recommend endodontic surgery, as he has in your case. This procedure not only debrides infection from your tooth’s root and the areas around the end of it, but it can also be very helpful in diagnosing other possible causes for this continuing infection. These problems may include cyst formation or cracked roots.
The reason that your dentist will send you to a specialist such as an endodontist or oral surgeon is because this treatment is much more challenging than a conventional root canal. These specialists are professionals in diagnosing and treating oral pain and are specially trained for these procedures and many others. In addition to four years of dental school, they have had in the area of two to five more years of advanced education, and have studied and performed this exact procedure to greater depths.
The procedure begins with a small opening in the gum tissue made in the area of the end of the root of the tooth in question. This will expose the underlying bone. After this, access is made to the end of the root(s) and this area will be cleaned out and explored first. Next, the root’s tip will be removed and the end of the root may require a small filling or seal known as a retrograde filling. A few stitches will be placed and usually after a few months, the bone in the area should heal nicely.
Your dentist has recommended an apicoectomy because it is probably the best option for you at this point. The only alternative would be to extract the tooth. You must then replace the tooth with an implant, bridge or a removable partial denture to maintain chewing function and prevent drifting of other teeth in the area. I agree that endodontic surgery is indicated for you at this time and it is the most cost effective. Remember, any replacement is never as good as your own natural tooth!
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5