Apicoectomy vs. Root Canal Therapy Redo

In this world nothing seems to work 100% of the time.  Unfortunately, although there is a 97% success rate for root canal therapy treated teeth, that does leave some issues to deal with in 3% of the cases.  Sometimes it can be years after the root canal therapy (also known as endodontic therapy) has been performed, and there will be symptoms of discomfort associated with the root canal therapy tooth, or an indication of infection is observed in an x-ray.  What should be done about this?

There are two directions your dentist can take.  One is to perform a surgical procedure called an apicoectomy.  What is an apicoectomy?  It is a surgical procedure that involves making a small incision in the gum tissue above the tooth in the area where the tip of the tooth root is.  Usually when this incision is made and the dentist takes a look under the gums where the incision was made, the dentist will see an area in the bone filled with soft tissue, instead of bone.  We don’t know why in some cases the anticipated healing and filling in of the bone at the tip of the tooth root does not take place after a root canal therapy (and in its place is soft tissue that has to be cleaned out).  However, when this happens, the soft tissue must be removed so that the bone can heal and fill in.  Sometimes the tip of the root is drilled away a little, and a dental filling may also be placed at the remaining root tip.  The success rate for healing the infection with an apicoectomy is approximately 90%.  There isn’t discomfort associated with having an apicoectomy, but there usually is a lot of swelling that occurs.  It’s an opportunity to get some sympathy because it looks like you need it, but you’re not in pain.

The other way to treat the infection is to repeat the root canal therapy procedure.  The success rate of redoing the root canal therapy is 75%.  In addition to having a lower success rate than the apicoectomy, it can be more difficult to redo a root canal therapy if there’s a dental crown on the tooth (which is common with teeth that have had root canal therapy).  If you opt for this approach, you need to be aware that the dental crown will need a filling to seal the opening needed to redo the root canal therapy.  If this would be a cosmetic concern, then a dental crown would need to be replaced as well.  For most people this isn’t a concern, because on back teeth, a tooth colored filling would not be particularly noticeable, and on front teeth, the filling wouldn’t be seen at all because the filling would be on the tongue side of the tooth.

Statistically, the apicoectomy is the preferred choice, but sometimes these decisions are more emotional than rational, and people opt for having a non-surgical approach.  We’re glad that there is another alternative for saving a tooth.

For information on other dental topics, please visit us at www.TavorminaDentistry.com, or call us at 973-761-5090.