Treatment
Endodontic microsurgery for Lutterworth
Where infection persists at the tip of a root and cannot be treated from inside the tooth, a small, precise surgical procedure removes the infected root tip and seals the canal from the outside. It is carried out under local anaesthetic, takes around an hour and gives a tooth that would otherwise be lost a further chance.
When it is recommended
- infection that has not resolved after root canal treatment or retreatment;
- a tooth with a post and a sound crown that would be damaged by reopening it;
- a canal blocked or sharply curved near the root tip;
- a cyst or lesion at the root tip that must be removed;
- a fractured instrument or extruded filling material beyond the end of the root.
Where retreatment through the tooth is feasible, it remains the first choice; surgery is reserved for cases it cannot resolve. It is proposed after careful assessment and the right X-rays, when it offers the tooth a better chance.
The procedure
- Anaesthetic. The area is numbed with local anaesthetic, exactly as for a filling.
- Access. The gum over the root is lifted as a small flap and a window a few millimetres across is opened in the bone above the root tip.
- Removing the infection. The infected tip of the root — typically the last two or three millimetres — is removed together with the inflamed tissue surrounding it.
- Sealing the root end. A small cavity is prepared in the cut root surface and filled with a biocompatible sealing material.
- Closing. The gum is replaced and held with fine stitches, removed about a week later.
Pressure and the sound of the instruments are normal; pain is not, and the area is fully numb throughout.
Recovery
Expect a few days of swelling, and sometimes bruising, which cold packs and ordinary painkillers keep comfortable. The majority of patients return to work the following day. Keep the area clean with a gentle mouthwash rather than brushing it for the first week, avoid strenuous exercise for a day or two and return for stitch removal. Healing of the bone is confirmed on a follow-up X-ray later in the year.
Outcomes and alternatives
Root-end surgery performed with magnification and current materials has good success rates. The outlook depends on the tooth — its bone support, the quality of its crown and the absence of a crack — and is compared honestly with retreatment and with extraction before you decide.