Apicoectomy - root canal surgery.

Like all dental procedures, root canal treatment may fail and the tooth becomes infected again. In most cases, root canal re-treatment is considered before an apicoectomy. Occasionally, a nonsurgical root canal procedure alone cannot save the tooth and endodontic surgery may be recommended.

An apicoectomy is an endodontic surgery that removes the tip (apex) of a tooth’s root and any inflamed or infected tissue, followed by placing a small filling in the root to seal the end of the root canal.

This case showed the big abscess from a tooth with failed root canal treatment. The tooth was an abutment of a dental bridge, which replaced the impacted eye tooth. It was a shame that the canine was not dragged down with orthodontic traction when the patient was young.

Apicoectomy was chosen as the treatment option over root canal re-treatment. Firstly, the gutta percha over-extension was significant. It's unlikely to remove it successfully with nonsurgical root canal treatment. Secondly, the obturation was adequate, which wouldn't cause re-infection after retrograde root filling.

During the procedure, the over-filled material, infection tissue and root tip were removed after the gum was raised around the tooth root. The root canal was retro-filled with MTA. Finally, the gum was closed with stiches.