Root canal treatments have a high success rate when it comes to saving an infected tooth – close to 95 percent. However, sometimes a standard root canal will fail and a surgical procedure known as an apicoectomy will be necessary.
Why Root Canals Can Fail
Dr. Jaqueline S. Allen, an endodontist with the Phoenix Endodontic Group, explained that there are a number of reasons that a root canal treatment might not be successful.
“Sometimes there is simply not enough tooth left to place a functional restoration,” Dr. Allen explained. “Other reasons for root canal failures can include a vertical fracture in the root that cannot withstand chewing on the tooth, a poor crown to root ratio, or an unusual root anatomy that creates difficulty in cleaning the entire root structure.”
Two other reasons that a root canal treatment might not succeed include a significant delay in the final crown being placed on top of the treated tooth, and when a successfully treated tooth develops an infection later, perhaps due to new cracks or fractures in the tooth, or additional tooth decay.
How an Apicoectomy Differs From a Root Canal
There are several significant differences between a standard root canal treatment and an apicoectomy:
- In a root canal, the endodontist approaches the treatment by going through the crown of the tooth. In an apicoectomy, he or she will perform the treatment by starting at the root (or apex) end of the tooth. To do this, he or she must make an incision and move the gums out of the way.
- During a standard root canal, the focus is on cleaning all the root canals in the tooth. For an apicoectomy, since the other canals have already been filled and sealed, the focus is on removing the infected tooth root and placing a small filling to prevent further problems.
- Because an apicoectomy requires a gum incision, stitches will be necessary, and bone grafts may be used to encourage your jawbone to fill in the area around the tooth root that is removed.
As far as recovery from an apicoectomy is concerned, Dr. Allen advised that patients should be prepared for possible post-operative bruising or/and swelling (which can be taken care of with the application of ice packs), and should allow one to two hours for the procedure itself. They should avoid vigorous exercise for several days and should avoid brushing in the area for two to five days. A return appointment to remove the sutures will also be necessary.