If a tooth that has been previously endodonticly treated develops an infection, there are certain surgical procedures that can be performed to save it.

Apicoectomy

 

Apicoectomy is one of the most common surgical procedures used to treat a periapical infection of a previously endodonticly treated tooth.  In some cases, it is the only possibility of saving a tooth, in others it is a way to avoid replacing an existing post and crown (which is a cost benefit).

Local anesthetic will be used.  Once the patient is numb, the gum above the tooth is cut and reflected away.  An opening in the bone, at the site of the infection is made, allowing access to the tip of the root, where the infection presents. The tip of the root is then cut away and a small spoon is used to clean out the infection tissue. Then the dentist will make a small cavity preparation at the tip of the root and fill it with a tiny amalgam filling, sealing the canal (Retrograde filling). The gum placed back and sutured back.

Hemisection and root amputation

 

Hemisection and root amputation are the procedures that are done in multi root teeth, when the infection is present at the apex of one of the roots. Hemisection is mostly done on the lower molars. The tooth is cut in half between the roots, the infected half of the tooth is removed and the remaining part is treated as a single root tooth.

The amputation is the surgical procedure of removing the infected root of multi-root tooth. The crown part of the tooth is not removed, but sealed with the filling material at the amputation side.



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Hemisection #19 10years after