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Home Patient Information Guidance on Surgical Endodontics

Surgical Endodontics (Apicectomy)

Teeth that have failed following root canal treatment (endodontics) are salvaged by surgical endodontics (Apicectomy). The aim of this treatment is to remove the infected tissue from the root tip and seal this area by a non- tissue irritating restoration. This treatment is more successful in single rooted teeth (upper and lower anterior teeth). However the failure rates go up with multirooted teeth.

There is strong evidence to show that periapical pathology is best treated endodontically even if a crown or a bridge is in place.

Symptomatic persistent periapical pathology is best managed by repeat endodontic therapy and if necessary by a specialist endodontist.

Essentials before Considering Surgical Endodontics
• Sound periodontal status and good Oral hygiene
• Good bone support for the tooth
• Adequate root filling with adequate apical seal and if necessary repeat root filling
• Sound coronal seal by either a restoration or crown

Indications
• Persistent signs and symptoms after repeated, quality good endodontics (Root canal treatment)
• Enlarging and persisting cystic lesions on repeat X-rays.
• Endodontics not possible because of sclerosed canals or broken instruments
• Lateral perforation in an accessible site.

Referral for Apical Surgery
Only patients meeting the above criteria should be considered for apical surgery referral.

Ref: RCS of England Web site and the FDS site