A tooth will need root canal therapy when the pulp, the tissue inside the root canal, has become inflamed or infected due to a variety of reasons: deep cavity, repeated dental procedures, a crack, or trauma. During root canal therapy the endodontist will remove the inflamed or infected pulp tissue, clean and shape, disinfect, and fill the space inside the root with a special sealing material. The endodontist will cover your tooth will a temporary filling, and subsequently, you will need to follow up with your general dentist to have the tooth restored permanently with a crown or other restoration to protect your tooth and establish full function of your tooth.
Root canal therapy is highly successful, and with proper care, most teeth with root canal treatment will last you as long as the rest of your teeth. However, a tooth which has had root canal therapy in the past may fail to heal and continue to exhibit discomfort. Endodontic re-treatment provides you with an additional attempt to try to save your tooth by simply redoing the root canal procedure. This is achieved by removing all the old filling material from inside the root and after cleaning and shaping the root, it is disinfected again and the space inside the root is sealed.
Occasionally, conventional root canal therapy or endodontic re-treatment may not be possible or the best option. An apicoectomy (surgical root canal) allows the endodontist to attempt to save your tooth in a variety of situations: persistent infection/inflammation around the apex of the root in the bone after root canal therapy, microscopic fracture, calcification within the root, or root damage due to resorption or trauma. During an apicoectomy, a small window is opened near the tip of the root through the gum and the bone, any infected/inflamed tissue including the very end of the root is removed, and a small filling is placed to seal the end of the root. The gum is sutured back to help the tissue heal properly.
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