Endodontic microsurgery involves surgically accessing the root tip or sides of a tooth to treat infection when it cannot be accessed non-surgically or if a cyst is present. It may also be used to remove an unsalvageable root to retain part of a multi-rooted tooth for function and aesthetics. The procedure utilizes an operating microscope and microsurgical techniques to profoundly numb the tooth, lift the gum, remove infected tissue, place a biocompatible material to stimulate bone growth, and close the site. Success rates for endodontic microsurgery are much higher than traditional surgery due to these advanced techniques.

1. What does Endodontic Microsurgery involve?
Julie K Kilgariff
Specialist in Endodontics
www.julie4endo.com
Previous failed
surgery
Day surgical revision
done
15 months after
surgical revision
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2. Endodontic surgery is useful for treating infection at the end
or sides of the root when the area cannot be accessed
non-surgically or when a cyst is suspected.
Less commonly, it is used to remove an unsalvageable root
from a tooth with more than 1 root (so that half of the tooth
– usually a molar – can be retained for chewing & aesthetics)

3. For example: This molar tooth originally had 2
roots.
The further forward root was cracked and could
not be saved.
Rather than extract the whole tooth which would
leave a sizable gap, the cracked root was divided
from the rest of the tooth and removed.
The remaining root was root canal treated and
used to support a small bridge allowing the tooth
to be used for chewing and completely filling the
space left by the extracted root
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4. For example:
This large dark shadow associated with the end of the
upper lateral incisor tooth was identified on x-ray after
the patient had pain.
There is a good quality root treatment already present. Owing to the size of
the dark shadow a cyst was suspected and arrangements made to remove
this surgically.
Having done this, the removed tissue was sent to a laboratory (which
confirmed that a cyst had been removed).
At 1 year review, a large amount of new bone infill at
the end of the root of the tooth can be seen. There is
still more healing to occur (where the small dark area
remains)
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5. Traditionally (until 1990’s), endodontic surgery had poor success rates.
Since the microscope was introduced into
endodontics & microsurgical techniques
developed, excellent success rates are
achievable.
Without using a microscope & microsurgical techniques, the success
can be very low indeed, some studies report less than 30%

6. Generally, the microsurgical
procedure involves:
1. The microscope is used
2. The tooth itself and neighbouring teeth are profoundly numbed
3. The gum is lifted to access the area of the root needed
4. Removal of infected soft and hard tissue +/- previous root filling
materials
5. A tissue-friendly (biocompatible) material is placed into the root
area to stimulate new bone formation around the tooth & ‘seal’
the root
6. The gum is placed back into position and held there with small
stitches (sutures).
7. The sutures are removed 3-5 days later
8. Review

7. Small stitches (sutures) at 5 day removal
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8. If endodontic surgery is thought
appropriate in your case, this will be
discussed at your assessment.
You will be given further information &
leaflets depending on the type of surgery
that it is.

9. If you have not found the
answers to your questions
regarding surgery here,
please contact us via the
email link
Crack in tooth identified during microsurgery
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