Endodontic micro surgery may be required when there is a persistent abscess in the bone that has become cystic or that can not be relieved through conventional root canal therapy.
Sometimes, endodontic treatment alone cannot save your tooth, and your dentist or endodontist may recommend endodontic surgery. Endodontic surgery includes any surgical procedures used to remove the infection from your root canals and surrounding areas. Surgery can also be used in diagnosing problems that do not appear on your x-ray, such as root fractures, or in treating problems in the surrounding bone.
Endodontists are dental specialists who diagnose and treat oral pain. They specialize in endodontic (root canal) treatment, including any treatment for the inner tissues of the tooth. In addition to dental school, endodontists receive two or more years of advanced education. They study root canal techniques and procedures in greater depth, including the area of endodontic surgery.
After the inflamed or infected tissue is removed, a small filling may be placed in the root-end to seal the root canal. A few stitches are placed in the gum to help the tissue heal properly. Within a few months, the bone heals around the end of the root.
A relatively new addition to the instruments used in dentistry, the operating microscope has been used by medical specialists for decades. Endodontists, the dental specialists who treat problems originating inside the tooth, began experimenting with microscopes in the early 1990s, using them to enhance surgical procedures they perform around the roots of teeth. The microscope helps not only by magnifying the surgical field but also by providing more light. In addition, tiny mirrors no more than one-tenth the size of traditional dental mirrors help the endodontist see into places where the human eye alone never could.
When endodontists perform endodontic (or root canal) procedures, the goal is to remove pulp tissue comprised of nerves, blood vessels, and connective tissue from canals inside the teeth. The canals are then cleaned, shaped and filled with a special material, and the tooth restored, usually with a crown. This procedure saves teeth when their internal tissues have been damaged by serious decay or other trauma. Without a root canal, these teeth would have to be extracted and replaced with expensive bridgework, partials, or implants.
In most teeth, a canal containing nerves and blood vessels runs from the center of the crown (the part you can see above the gumline) of the tooth through the root and out into the jaw. Near the end of the root, the canal branches into many smaller canals, almost like a river delta. These smaller branches of the canal can be much easier to see with the microscope.
After initially using the microscope in surgery, many endodontists discovered that it can also help with diagnosis and nonsurgical endodontic procedures. Endodontists have used the microscope to find tiny fractures, which are often difficult to detect with traditional diagnostic methods. In addition, very small or unusually positioned canals become easier to see.
Sometimes, a new infection or injury will cause a tooth that has been treated before to need a second endodontic procedure. Endodontists call this “retreating” the tooth. To accomplish retreatment, all previous filling material and posts that may have been placed to support a crown must be removed from the tooth. The microscope can help with these procedures as well.
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