Endodontist Questions Root end resection

What can be the risks involved in an endodontic surgery?

Are there any risks involved in an endodontic surgery, specifically a root-end resection? I am also a diabetic and I just want to weigh all the risks before giving permission for anything.

10 Answers

Root end resections are not as popular as they once were. Maxillary molar surgery can involve the sinus and bottom molars can cause parasthetia because of the proximity of the mandibular nerve.
You definitely have some risks involved with any kind of surgery. But for endodontic surgery, the risks are bleeding, swelling, infection, sinus perforation in upper back teeth, inferior alveolar nerve injury in lower teeth, short or long term, may even be permanent numbness to name a few.
There is always risk for any treatment. Your doc should go over them with you. With apicos (root end resection), some of the biggest risks are, but not limited to:

1) it might not work
2) infection
3) pain and swelling, bruising
4) depending on where it is being done, you can get a sinus perforation, or damage to the mandibular nerve.

Make sure you know of the alternative of retreating the tooth. 99% of the root canals I see are treated with retreatment first. Apicos are last ditch efforts to save a tooth. Most failures of older root canals are a reinfection. An apico does not deal with that. In general, the apico is only done when the dentist thinks there is a secondary canal at the root tip and they want to cut it out.

Being a diabetic, you are at risk of not healing up as well. The less controlled diabetic you are, the higher the risk involved.
The common effects of surgery are bleeding, pain, and swelling. There are other risks that are more site specific, i.e., if the infection is close to a nerve or blood vessels or maxillary sinus. There should not be much greater risk of surgery if the diabetes is well-controlled (assuming no other health issues).
No, just let your dentist know if you are on blood thinners and consult with physician before going. If you take a pre med before dental treatment, you would take it before endo treatment as well.
Yes. There are always risks with any procedure. Some of the possible risks are permanent nerve damage where you could feel numb in the area for months to years or forever. The position of the hebtooth in relation to nerves and vessels in the area will determine the percentage of risk. There is also risk of bleeding, bruising, nausea, damage to other teeth. Possible presence of vertical root fracture and the need to extract the tooth. Your endodontist could send you for a specific radiograph called CBCT to determine proximity to important anatomical landmarks and weigh the risks. Also being a diabetic, there is a higher risk of delayed healing.
I hope I opened your eyes to further discuss your risks and options with your endodntist before proceeding.
There's virtually no risk for endodontic surgery on a top tooth, but there's possibly considerable risk for a lower back tooth. A 3D Cone Beam Scan can help insure minimal risk. Most well-controlled diabetics have absolutely no problems whatsoever undergoing this type of procedure under typical local anesthesia.
There are risks associated with ALL surgery, that includes endodontic surgery. The usual risks include bleeding, bruising, nerve damage, unsuccessful outcome, pain, swelling, jaw fracture, sinus perforation, lost roots, poor healing and more. Depending on the location of the tooth/root, some problems may be more likely than others. Of course, the same risks
occur with extractions, implants, periodontal surgery, etc. This is the main reason why I recommend re-treatment of the root canal rather than surgery as a first choice. Most endodontists are retreating root canals that did not respond to the original treatment rather than surgery. Re-treatment offers a higher success rate when performed by an endodontist
compared to surgery on an infected root. If the tooth is properly cleaned out, then surgery success rates rise. Of course, re-treatment is usually more time consuming and will damage the crown, necessitating a new post and crown. Surgery is faster, but if it doesn't work, then what?
Many of the answers regarding endodontic surgery can be found on the AAE website. Here is the link:

https://www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-surgery/

Brett E. Gilbert, D.D.S.
The main risk of endodontic surgery is that it may not be successful every time. However, there are other secondary risks that you should be aware of. There is the possibility of infection, pain, excessive bleeding, paresthesia (temporary or semi-permanent nerve damage), gum recession, bone loss, scarring of the soft tissue, etc. The chances of any of the above happening are small, but you should be aware that there is a small possibility of these risks, as is the case with any procedure.