Non-surgical endodontics, also known as root canal treatment, is the first-line treatment option to deal with dental pulp that is inflamed or infected. It is a common dental treatment technique that accesses the pulp and the root canals through the crown of the tooth. The aim of root canal treatment is to access and clean up these infected areas by removing the pulp, and afterwards to seal the cleaned cavity (root filling) to prevent further infection in the future. It follows the philosophy that wherever reasonably possible, natural teeth and their structures should be preserved.
Even if nowadays the success rates for root canal treatment are high, failed conventional root canal treatments remain the main indication for surgical endodontics, essentially as a salvage option only to be considered if a second, conventional root canal treatment attempt is not possible (or also failed). Obviously, the cause of failure of the initial root canal treatment needs to be established before considering surgical endodontics. However, there are further indications for surgical endodontic interventions, including
- obtaining a biopsy from a lesion in the area near the tip (periapical) of a tooth root;
- repairing defects of, or damage to, a tooth root;
- resecting / removing parts of a tooth with complicated multiple roots that are inaccessible to conventional, non-surgical endodontics.
The surgical endodontics approach is a different access route to the dental root canals and pulp and as a result is less useful in obtunding the entire root canal system. Rather than through the crown of a tooth, access is gained through an incision in the gingiva (gums), a flap is raised to access the tip of the tooth root(s) directly. There are several stages of the procedure (the majority of which are carried out in an outpatient setting):
- local analgesia;
- incision and raising of a suitable flap for access;
- haemostasis (reducing bleeding) to maintain good visibility in the area;
- identification of the root apex (tip of the root);
- periapical curettage (clearing the area surrounding the tip of the root);
- root end resection (removal of the tip of the root);
- root and cavity preparation;
- root end (retrograde) filling;
- wound closure.
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