Root End Surgery in Central Hamburg

This procedure is necessary in case of chronic inflammation near the root end when classical root canal treatment has not been effective. One reason for root end resection could be that caries has spread inside the tooth.

Severe pain can arise from such an infection and can stem from the fact that blood vessels are dilated by the inflammation pressing on the nerve in the tooth. Furthermore, bacteria can spread to the tip of the root at this stage of the disease and attack the jaw from there. If left untreated, bacteria can enter the bloodstream as another consequence of this process and affect overall health.

What Is Root End Surgery?

Apicoectomy, as it is also called, is a dental intervention within the branch of endodontics – a discipline for the treatment of the interior of a diseased tooth.

The Aim of Root End Surgery

Root end surgery is used to remove the root end of a tooth. This procedure is a necessary treatment for maintaining teeth in the jaw after they have suffered from bacterial infections such as tooth decay or other root canal infections.

The most important information at a glance

Root end surgery

Suitable for:Sensible tooth preservation
Anaesthetic:Local anaesthetic, sedation possible if necessary
Necessary for:Failed root canal treatment
Examination:Clinical and X-ray
Advantages:Tooth preservation where possible
Time:20-60 minutes
Costs:Covered by health insurance, 120 – 280 EUR with MTA cement

Advantages of the Dental Clinic ABC Bogen

Thanks to modern treatment techniques, new instruments and filling materials, the use of the surgical microscope and our many years of experience, we can today preserve teeth for which there was no hope of rescue in the past.

  • root canal treatment is microscopic
  • laser-assisted measuring methods – endometry
  • thermoplastic filling processes
  • optimal filling materials
  • ultrasound-assisted treatment
  • Photoactivated Disinfection (PAD) for cleaning the smallest areas

These modern methods of endodontology can in many cases ensure the preservation of teeth whose root canal system is infected. In so doing, the bacteria in the root canal system – the cause of the inflammation – is eliminated with a relatively small amount of intervention.

This modern method of treatment requires no additional surgery and usually saves you the cost of a dental prosthesis, such as a dental implant or a dental bridge.

Process of Root End Surgery

An endodontic procedure is used for tooth preservation. Elimination of the infection should prevent its spread into the interior of the tooth, including the possible consequences. Preservation of the tooth is important: it must be provided with a filling or a crown after the surgery.

1. Step: Localising the infection

First of all, the infection in the area of the root end is precisely determined. If the diagnosis shows that this inflammation cannot be treated with regular root canal treatment, the root end surgery is performed under local anaesthetic. Generally, this process takes about half an hour. Depending on the complexity of the individual infection, the treatment may take less time.

2. Step: Removal of the infected tissue

In a classical root canal treatment, the tip of the root is reached through the tooth crown. For root end surgery, this is usually different: instead, the root end is made accessible through the jawbone from the outside.
Furthermore, the gum and periosteum of the affected tooth are severed in the surgical procedure to access the root end. This is below the jawbone, which is removed until the inside of the tooth is visible. This creates the prerequisites for the next step, in which the infected tissue is removed around the root.

3. Step: Removal of the root end

As a rule, the tip of the root is shortened by about three millimetres. In exceptional cases, this must be reduced even more, for example in the case of considerable curvature of the root or if an extremely fine instrument has been broken off in the root canal and left unnoticed from a previous root canal treatment.

In the next step, the treated area is thoroughly disinfected and then the root canal sealed with a special filling. The tissue that has been separated for the treatment is now folded back, and the resulting wound is sutured.

Thanks to another set of X-rays, the root end surgery and the filling of the root canal can be checked again.

4. Step: Ensuring success and healing time

Healing of the wound in the soft tissue of the tooth interior after root end surgery usually takes seven to ten days, after which the sutures are removed. After around three months to half a year, you will be asked to return to the clinic to check the healing process in the area of the bone using X-rays. This check-up also verifies the success of root end surgery.

Risks of Root End Surgery

Root end surgery is not advised if the general health condition will be affected adversely. If a significant improvement in the jaw is unlikely, root end surgery is not recommended: in the case of a barely existing or already extensively damaged periodontium, it is recommended that the tooth affected by infection be removed at the tooth root.

Recovery Tips After Root End Surgery

Only eat again after effects of the local anaesthetic have completely disappeared. It is also highly recommended that you abstain from smoking and coffee for 24 hours after therapy to ensure the healing process. You should also refrain from physical exertion on the day of the operation and on the following day. A flannel soaked in cold water may prevent or alleviate any swelling and possible bruising resulting from root tip therapy. After successful root end surgery, special attention should be paid to thorough oral hygiene to support the healing process. This will prevent the re-spreading of bacteria in the mouth.

Costs of Root End Surgery

The cost of root end surgery and a traditional root canal treatment are sometimes dependent on each other.

If the tooth is considered worth preserving, the costs may sometimes be borne by statutory health insurance. The health insurer may refuse coverage in some cases, especially for back molars. In this area of the mouth, health insurance companies cover the costs of a root canal treatment only if one of the following conditions is met:

  • The affected molar lies in a gapless row of teeth
  • The root end surgery prevents a shortening of the row of teeth from the rear out
  • The root end surgery will ensure the preservation of an existing denture

In general, the cost of root canal treatment when prospects of success are uncertain is not covered by statutory health insurance companies. The same applies to the use of certain special treatment techniques. In these cases, root canal treatment needs to be undertaken privately.

If the root canal treatment has been approved by the health insurer and then root end surgery is then required, the statutory insurance usually covers the costs.

Do you have questions about your individual treatment? We look forward to assisting you.

Frequently Asked Questions

As an experienced specialist in root end surgery, Dr. Stefan Triebswetter is happy to advise you.

Yes, a very small cut of the lining of the mouth is necessary.

You can eat most foods, but be careful with dairy products, caffeinated beverages, as well as hot food and drink.

The extraction of the respective tooth.

Root capping should be considered the last attempt to preserve the tooth. In the absence or failure of such a treatment, the tooth must be extracted.

No, with local anaesthetic you only feel pressure and vibration but never pain.

If it is a tooth that has only one root, you can usually work again the next day. With multi-root teeth it could be that you have to stay at home for one or two days.

Depending on which tooth is involved, between 20 minutes and 1 hour.

We work with state-of-the-art materials that are currently on the market and sufficiently scientifically proven. These include mineral trioxide aggregate cement (MTA) and super EBA cement. In addition, microsurgical instruments are used in order to achieve the best results with maximum tissue preservation.

Because with the help of a microscope, a better overview can be achieved, which is of considerable importance in root capping, since it is often an anatomically difficult to see area. In addition, this can be done even more tissue-preserving.

A simple root capping without microsurgical measures is included in the services of statutory health insurance. When agreeing to the use of microsurgical measures and very expensive MTA cement, you have to pay between 120 and 280 Euro per tooth. As a rule, private health insurance covers all costs.

In the early stages, a root treatment can be attempted. If the inflammation has spread, only root capping can accomplish the goal.

If the treatment is successful, the tooth can be saved and the dentures attached to the tooth (crown, bridge, etc.) can be carried on

One can do a second try. This must always be considered individually. Even if the tooth is cut for the second time, it should still have a sufficient length.

If we can still save the tooth by a root capping, then the capping is always better. You can still extract the tooth, but you should also consider the consequences of a tooth gap.

Not necessarily, if a root canal treatment successfully heals the inflammation, then root capping is not necessary.

Yes, if the inflammation is not very extensive. This can be assessed quickly with an X-ray.

Yes, with successful root capping.