Oral surgery
Some problems cannot be solved from inside the tooth. Oral surgery reaches them from outside, often to keep a tooth that would otherwise be lost.
Apical surgery: the last chance before extraction
When a root canal does not fully heal and cannot be redone from the inside — because of a post, a crown that cannot be removed, or impossible anatomy — one route remains: treating the tip of the root from outside.
Apical surgery means reaching the root tip through the bone, removing the infected tissue, cutting away the last millimetre and sealing it. The tooth stays in the mouth.
This is one of Dr. Gaviño’s published lines of work: one of his papers documents apical surgery combined with regeneration, with six years of follow-up confirmed by CBCT.
Many patients arrive here after being offered extraction as the only option. It is not always the only one.
Microsurgery
What separates classical apical surgery from microsurgery is the microscope.
With magnification and dedicated lighting the opening in the bone can be far smaller, the exact end of the canal is visible, and any cracks explaining the failure can be seen. Less tissue disturbed means less swelling afterwards and a faster recovery.
It is the same microscope used for root canal work. It is not brought out for special cases: it is part of how the work is done.
Wisdom teeth and impacted teeth
Removing a wisdom tooth can be straightforward or anything but, depending on where it sits and what lies next to it. The inferior alveolar nerve and the maxillary sinus are millimetres away.
That is why these procedures are planned with CBCT where indicated: in three dimensions the exact relationship between root and nerve is visible, where a flat X-ray leaves it to guesswork.
Impacted teeth that never erupted — canines in particular — are also treated, sometimes exposed surgically so that orthodontics can bring them into position.
Pre-prosthetic and soft tissue surgery
Before a prosthesis or an implant, the ground sometimes has to be prepared: reshaping bone, managing gum volume, or correcting attachments that stop a prosthesis seating properly.
Mucogingival surgery is also carried out, treating gum recession and soft tissue problems around the teeth.
Before any procedure
No surgery begins without proper imaging and without explaining what will be done, what to expect and what the alternatives are.
Where CBCT is indicated, it is used. Skipping it to save on it means operating with less information than was available, and in surgery that cannot be recovered afterwards.
Scientific publications
- 2021 Dentin Growth after Direct Pulp Capping with the Different Fractions of Plasma Rich in Growth Factors (PRGF) vs. MTA: Experimental Study in Animal Model Journal of Clinical Medicine
- 2021 Regenerative endodontic procedure combined with apical surgery of a necrotic permanent incisor with extensive periapical lesion using plasma rich in growth factors (PRGF): A Case report with 6 years post-op evaluation using CBCT Journal of Clinical and Experimental Dentistry
- 2020 Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3-year follow-up International Endodontic Journal
- 2017 Use of Platelet-rich Plasma in Endodontic Procedures in Adults: Regeneration or Repair? A Report of 3 Cases with 5 Years of Follow-up Journal of Endodontics
Frequently asked questions
- Does apical surgery hurt?
- The procedure is done under local anaesthetic and is not painful. There are a few days of swelling and tenderness afterwards, managed with the prescribed medication. With microsurgery the opening is smaller, so recovery tends to be milder.
- Is surgery better than extraction and an implant?
- It depends on the case, but the approach here is to try to keep the tooth first. Apical surgery with a good prognosis is preferable to losing the tooth, because no implant reproduces the behaviour of a natural root.
- How long does recovery take?
- The first two or three days involve the most swelling. Most patients carry on normally from the start, with some care over diet and hygiene in the area. Stitches come out after about a week.
- I need a wisdom tooth out. Is a CBCT necessary?
- Not always, but yes when the root lies close to the inferior alveolar nerve or the maxillary sinus. In those cases seeing the exact relationship in three dimensions changes how the extraction is approached and lowers the risk.
- Can I eat and carry on normally afterwards?
- Yes, with care: soft, cool food for the first days, no vigorous rinsing, no smoking, and following the hygiene advice given. Written instructions are provided after the procedure.
Before giving up on a tooth
If extraction has been proposed, it is worth assessing whether a surgical alternative could keep the tooth, and how a second opinion works. An assessment commits you to nothing.