Getting to Root of Woes
February 3 2000

Dear Dr. Mady: I had a root canal on one of my teeth two years ago because of an infected nerve. I have been experiencing infections off and on since, and now my dentist thinks that I should be referred to a specialist for a procedure called an apicoectomy. Why do you think this is happening, and what is this procedure all about? - Wally in Belle River

Dear Wally: It is not unheard of for this to occur after root canal treatment. Sometimes it occurs immediately, or it may be years later. Before I can explain why this is happening, and what an apicoectomy is, it is imperative that you understand the non-surgical portion of endodontic (root canal) therapy.

The reason you needed root canal therapy is most likely because of severe inflammation or infection of the tooth pulp. The pulp is the inner tissue inside your tooth's root made up mostly of nerve fibres and blood. When this tissue becomes damaged, it must be removed and replaced with a rubber-like filling material to stop the entrance of more bacteria through the root's apex (the opening at the end of the root). If more bacteria are allowed to enter, recurrent infections and damage are unavoidable.

Sometimes a root canal alone is not going to solve the problem completely, and your dentist might recommend endodontic surgery, as he has in your case. This procedure not only debrides infection from your tooth's root and the area around the end of it, but can also be very helpful in diagnosing other possible causes for this infection.

Your dentist will send you to a specialist such as an endodontist or oral surgeon because this treatment is much more challenging than a conventional root canal. These specialists are specially-trained professionals in diagnosing and treating oral pain.

In addition to four years of dental school, they have had two to five more years of advanced education, and have studied and performed this procedure more extensively.

The procedure begins with a small opening made in the gum tissue near the end of the tooth's root to expose the underlying bone, and gain access to the end of the root or roots. The area will be cleaned out and explored.

Next, the root's tip will be removed and the end of the root may require a small filling or seal, known as a retrograde filling. A few stitches will be placed and usually after a few months, the bone in the area should heal nicely.

Your dentist has recommended an apicoectomy because it is probably the best option for you at this point. The only alternative would be to extract the tooth. You must then replace the tooth with an implant, bridge, or partial denture to maintain chewing function and prevent drifting of other teeth in the area.

I agree that endodontic surgery is indicated and it is the most cost-effective. Remember, any replacement is never as good as your own natural tooth.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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