Root canal treatment is needed when your tooth's pulp (nerve) is inflamed or infected. Some reasons of pulpal inflammation/infection include deep dental decay or trauma.  It is often quite straightforward and the procedure is done to save your tooth (teeth). During root canal treatment, we will carefully remove the pulp inside the tooth, clean, disinfect and shape the root canals in order to place filling materials to seal the canal spaces.  In a timely manner (typically sooner than one month), it is important to have your dentist place a final restoration so as to protect the root canal treatment and to prevent reinfection from occurring.  

In certain circumstances, a tooth that has had root canal therapy can get reinfected (i.e. In cases where new decay forms underneath a crown or if trauma creates cracks where bacteria can enter and reinfect).  In these cases, Re-Root canal therapy (Retreatment) is indicated. During retreatment, we will re-access your tooth and remove any filling materials that were placed in the root canals during the first procedure.  We will then carefully examine the tooth, looking for additional canals or new infection. We will then remove any decay & infection, clean and shape the canals, and place new filling materials.

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Sometimes, non-surgical root canal therapy is not enough to save your tooth and we may recommend endodontic microsurgery. Endodontic surgery success has dramatically improved the last decade due to improved visibility with microscopy, improved sealing materials, improved armamentarium and improved imaging.  Surgery can be done to locate small fractures or hidden canals previously undetected or for canals that cannot be cleaned out due to excessive calcium deposits or for canals that cannot be fully cleaned out with non-surgical treatment.  Sometimes, surgery is indicated if there is an additional infection outside the root damaging root surfaces or the surrounding bone of the tooth.  

There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which may be needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. 

After applying good local anesthesia, the gum tissue is opened slightly and infection or any inflamed tissue is removed.  The root end is removed and sealing material is placed at the end of the root canal.  Few stitches are placed to help heal the tissue and you must return for post-operative evaluation and suture removal.  In the next few months, the bone will heal around the end of the root(s). Most patients return to their normal activities within the next few days and post-surgical discomfort is generally quite mild.


Intentional replantation is another type of surgery where the tooth is gently extracted, placed in a special medium to keep periodontal ligament cells alive. Then the infection is removed, the root end is treated appropriately, and the tooth is re-implanted into the socket.   This procedure is recommended for cases where normal apicoectomy cannot be performed and the tooth's roots are shaped so extraction without disturbing the roots is possible.  Post op discomfort is usually minimal and healing takes place within a week in most cases.  

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