Editing Endodontics (section)

=== Periradicular surgery ===
{{Main|Periradicular surgery}}
Periradicular surgeries involve the root surface. These include apicoectomy (removal of a root end), [[root resection]] (removal of an entire root), repair of an injured root due to perforation or [[Tooth resorption|resorption]], removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.<ref>{{Cite web|url=https://www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-surgery/endodontic-surgery-explained/|title=Endodontic Surgery Explained|website=American Association of Endodontists|language=en-US|access-date=2019-12-14}}</ref><ref name=":6">{{Cite web|url=https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/aae_2017guidetocdt.pdf|title=Endodontists' Guide to CDT 2017|date=2017|website=American Association of Endodontists|pages=11–14|access-date=2020-03-14}}</ref>

==== Apicoectomy ====
{{Main|Apicoectomy}}
An apicoectomy is a surgical procedure through which the apex of a root is resected, and a root-end filling is placed, preventing bacterial leakage into the root canal system from the [[Periapical|periradicular]] tissues.<ref name=":4">{{Cite journal|last=von Arx|first=Thomas|date=January 2011|title=Apical surgery: A review of current techniques and outcome|journal=The Saudi Dental Journal|volume=23|issue=1|pages=9–15|doi=10.1016/j.sdentj.2010.10.004|issn=1013-9052|pmc=3770245|pmid=24151412}}</ref> A microsurgical technique is used to carry out apicoectomy, which improves post-operative healing.

An apicoectomy can be carried out when a previous root canal treatment fails, and re-root canal treatment is not possible.<ref name=":4" /> This may be as a result of anatomical features, such as root dilaceration, which can compromise the completion of cleaning and obturating the root canal system. Procedural errors, including ledges or perforations, may also be indications for an apicectomy.

Local anaesthetic is utilised to achieve anaesthesia as well as [[Hemostasis|haemostasis]] for improved visualisation. A [[Flap (surgery)|flap]] in the gum is designed, and then raised to allow for exposure of the periapical lesion.<ref name=":5">{{Cite journal|url=https://sdsjournal.com/article/view/1747|title=A case of periradicular surgery: apicoectomy and obturation of the apex, a bold act|journal=Stomatological Disease and Science|year=2017 |doi=10.20517/2573-0002.2016.08 |language=en-us|access-date=2020-03-05|last1=Locurcio |first1=Lino Lucio |last2=Leeson |first2=Rachel |volume=1 |issue=2 |doi-access=free }}</ref> Bone removal ([[osteotomy]]) is carried out to enable access to [[Root apex (dental)|root apex]], and diseased tissue is removed at this point through [[curettage]].<ref name=":5" /> The root end resection is carried out, removing 3mm apically. The canal(s) is then obturated, and the flap is sutured. There are a number of root-end filling materials available, including [[zinc oxide eugenol]] cements, and [[mineral trioxide aggregate]].

Complications that may arise include:

* pain: anti-inflammatory agents or analgesics should be taken
* swelling: intermittent ice will aid in eradicating this. Swelling resolves usually within 24–48 hours. 
* [[Bruise|ecchymosis]] (discolouration): this will often occur distant from the surgical site
* [[Paresthesia|paraesthesia]]: usually transient as a result of inflammatory swelling, and sensation will return to normal in 4 weeks
* serious infection is rare, but can be treated with antibiotics, which should be administered with caution to avoid bacterial resistance <ref>Siqueira JF, Rôças IN. Microbiology and treatment of endodontic infections. In: Hargreaves KM, Cohen S, Berman LH, editors. Cohen’s pathways of the pulp. 11th ed. St Louis: Mosby Elsevier;
2016. p. 599.</ref>
* [[maxillary sinus]] perforation <ref>{{Cite journal|last1=Hauman|first1=C. H. J.|last2=Chandler|first2=N. P.|last3=Tong|first3=D. C.|date=February 2002|title=Endodontic implications of the maxillary sinus: a review|journal=International Endodontic Journal|volume=35|issue=2|pages=127–141|doi=10.1046/j.0143-2885.2001.00524.x|issn=0143-2885|pmid=11843967|doi-access=free}}</ref>