Root end surgery is the last resort for tooth preservation. If neither the root canal treatment nor the root canal retreatment yielded satisfactory results, root end surgery offers the possibility to eliminate previously unresolved problems.
Indications for Root End Surgery
As a rule, if persistent discomfort in a root canal treated tooth can be attributed to insufficient disinfection of the root canal system, root canal retreatment is always performed before root end surgery. Root end surgery without prior cleaning of the above canal parts is not very promising!
In rare cases the infection of the root canal system can be very stubborn due to complex anatomical characteristics, and can be hard to get a handle on despite root canal retreatment. The presence of real cysts, which attach to the root ends, can be an indication for root end surgery (see image 1). Very deeply broken-off root canal instruments, which cannot be removed via the crown, can be removed with root end surgery. Even the occasional pressed-over root canal filling material can be corrected with resection.
Thanks to ultramodern anaesthetics, the treatment is pain-free in most cases. The root end is exposed with a small cut into the gingival tissue. The root end, including its finely branching root canal system is slightly shortened under microscopic view; inflammatory processes, cysts or over-pressed filling materials are removed at the same time (see image 2). Afterwards the root is worked on from the backside with special ultrasonic instruments and then sealed with special cement (see image 3). Subsequently, the gingival cut is sutured with very fine stitches (see image 4). In ideal cases, bone regeneration and resolving of the inflammation can be seen during check-ups (see image 5).