When and how are microsurgical procedures necessary?

If symptoms persist even after a root-canal filling has been carried out fully correctly, it is possible that the tooth possesses a microscopically fine fracture or a previously unidentified toot-canal system. In that case the underlying cause can be found and treated with a surgical procedure.
Sometimes canal systems can’t be cleaned and filled perfectly because of extreme calcification or even medical practitioner error. In this case, the tip of the root can be removed enabling the canal to be cleaned and sealed from its end. Every single step of this procedure is observed with a microscope; apart from the actual surgery the root-canal is also treated.

  •  Inflammation in the in the jawbone
  •  Under-filled, infected root-canal system
  •  Gutta-percha
  •  Post
  •  Crown

Preparation of access to the tip of the root’s inflammation, excision of the infected tissue.

  •  Gum flap

  •  Reverse filling of the tip of the root
  •  Sealing the gum with a suture

  •  Final situation with healed bone-tissue

Whenever possible the first step is to attempt to improve the state of the root-canal. Subsequent surgical procedures are much more likely to be successful. Today surgical endodontics are unthinkable without the use of micro-surgical instruments and a microscope. The literature reports failure rates of up to 50% failure of such micro-surgical procedures. Evidently such failure rates are caused predominantly by failing to clean and seal the root-canal system fully. This in turn is due to inadequate illumination and low levels of magnification of the tooth being treated, antiquated treatment techniques and a lack of experience of the pathophysiology of endodontic diseases.

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