Endodontics is the dental specialty that deals with the nerves of the teeth. When a tooth becomes infected it is usually related to the nerves in the root of the tooth. The infected nerves need to be removed. If left untreated an infection can turn into an abscess, which is a much more serious problem that includes bone loss in the jaw.
The area around the tooth is numbed with a local anesthetic to start the procedure. The dentist will then drill down into the tooth to create an opening into the canal. They will then be able to remove infected tissue and clean the canal. After the infection has been removed, the space if filled with a sealant called gutta percha. It is highly recommended that a tooth that has undergone a root canal have a crown placed as well. This will improve the strength of the tooth and will also make it much more likely that the root canal is successful.
An apicoectomy is performed after an unsuccessful root canal. When an infection will not go away or returns after a root canal has been performed this procedure is usually necessary. There can be multiple nerve pathways in a single tooth that may contain the infected tissue, so it is difficult to ensure that all of the infection is removed during a root canal. During an apicoectomy, the tip of the root of the tooth is removed and replaced with a filling.
In most cases a second root canal is considered before an apicoectomy since it is a simpler, less invasive procedure. Before the apicoectomy begins you will be given a local anesthetic to numb the area. The doctor will start by making an incision in your gum to expose the root of your tooth. Any inflamed tissue will be removed to clean out the area. The surgery takes place in a very small area, and only a few millimeters are removed from the root. Over the course of the next few months the bone will heal around the root.