If an infection develops in a tooth after it has had root canal treatment and the problem is related to failure of the root canal treatment, there are three choices to manage the problem. The root canal treatment can be redone, the tooth can be removed, or periapical surgery can be performed. Redoing the root canal can be a good option but extensive dental work on the tooth or the presence of a post placed in the canal can make it difficult. For example, removal of the post can result in fracture of the root. If the root is fractured for any reason, repair is not possible and the tooth must be removed. The diagnosis of a root fracture can be a diagnostic challenge as it may not be visible on an X-ray.
Periapical surgery is statistically a very successful procedure if the problem is a leaky root canal filling and the root tip is surgically accessible. Generally this is a painless procedure performed under local anesthesia. An incision is made and the root tip exposed. If a cyst or granuloma is present, it will be removed and possibly biopsied. The infection and inflammatory tissue will be removed and the tooth root inspected. If no fracture or other irreparable problem is found, a filling will be placed at the root tip to seal the canal. Dissolvable stitches are then placed. Swelling and pain postoperatively are usually minimal.
If removal of the tooth is necessary, insertion of a dental implant may be a good solution.