Step by Step Description



Step By Step Description of Microsurgical Endodontics or Apicectomy

 Please play video of apicectomy procedure.



- 2% lidocaine with 1:50 000 epinephrine (recommended local anaesthetic)

- papilla retained incision technique

- elevation of full flap and pin point precision for location of osteotomy window

  • groove technique to safely protect flap and protect nerve
  • surgery performed under stereomicroscope

- 5mm optimum size of osteotomy window with Linderman bur in safety handpiece

- curette infected tissue and remove 3mm of apical root tip at 0 degree bevel

- investigate surgical site for any other cause of root infection (such as root cracks, perforations etc.)

- parallel reverse root canal preparation with endo ultrasonic tips to 3mm

- copious irrigation with sterile water or saline with use of ultrasonics

- stain surgical site with methylene blue to look for micro-cracks or isthmus

- dry cavity site with Stropko syringe and maintain osteotomy window dry with cotton pelletts (if necessary)

- pack root end filling and check surgical site again (GTR may be necessary)

- suture flap closed without tension with 5/0 or 6/0 monofilaments for primary intention healing

- apply wet gauze to co-apt flap for 5 min

- give clear verbal and written post op instructions


Tell me why I need surgery


  • Surgery can help save your tooth in a variety of situations.
  • Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
  • Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this “calcification”, your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
  • Surgery may be indicated when a tooth has an abscess and is restored with crown/bridge and post, which cannot be removed for a number of reasons
  • Usually, a tooth that has undergone root canal therapy can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
  • Surgery may also be performed to treat damaged root surfaces or surrounding bone.


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