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Understanding Periapical Surgery

14 December 2024

Periapical surgery is generally advised only if the root canal treatment has been completed to a high standard or retreatment of the root canal is not possible due to an obstruction in the tooth.


The procedure involves making the area numb with an anaesthetic, the gum will be raised to access the end of the root. The lesion (abscess or cyst) is then scraped out/ removed and an extra filling (medicament) is placed at the end of the root.


Any queries or concerns regarding this procedure will be answered at the consultation appointment and if needed, a sedation option can also be discussed.



A diagram of a tooth being removed from the gums.

Decompression- The lesion at the end of a tooth can sometimes be quite large due to compression of the fluid within it and potentially become a cyst. These teeth can usually be effectively treated with root canal treatment and a saline wash of the large cystic space. This space is often left open with a stent and is rinsed with saline every few hours is required to "decompress" this lesion.


This decompression technique allows the analysis of the internal fluid and the lining of the lesion. If there is any uncertainty about the diagnosis then a referral is made to the Oral Maxillofacial Specialist. If the fluid is clear or straw coloured and histopathology of the lining is as expected then the decompression procedure is usually sufficient as long as a good root filling is in place.



A regular and thorough check of this is required to ensure the lesion is healing and there is no sign of infection.

A diagram showing the development of a cyst and a stent in place to decompress it.

These teeth can usually be effectively treated with root canal treatment and a saline wash of the large cystic space. This space is often left open with a stent and is rinsed with saline every few hours is required to "decompress" this lesion.


This decompression technique allows the analysis of the internal fluid and the lining of the lesion. If there is any uncertainty about the diagnosis then a referral is made to the Oral Maxillofacial Specialist. If the fluid is clear or straw coloured and histopathology of the lining is as expected then the decompression procedure is usually sufficient so long as a good root filling is in place.



A regular and thorough check of this is required to ensure the lesion is healing and there is no sign of infection.

A 3d model of a tooth with a hole in it.

Understanding Root Canal Retreatment

14 December 2024
Sometimes the root canals are very fine, calcified or blocked. These can be difficult to access and an Endodontist has specialist equipment including an Operating Microscope. This treatment can be done over 1-2 appointments. The Endodontist will discuss this and the cost with you during your consultation appointment. If the root canals are not able to be cleaned completely they can become infected causing an abscess at the end of the root. The tooth is carefully examined prior to treatment to assess this risk. The added risk is the strength of the tooth following root canal treatment. The structure of the dentine changes with the collagen component becoming weaker. The sides of a posterior tooth are at risk of fracturing following root canal treatment and added protection is needed. Often a crown is required which is done by your General Dentist, however a 6-12 month observation period is suggested before this is done to check that the treatment has been successful. 
A young boy is laying in a dental chair with an oxygen mask on his face.

Understanding Sedation

5 December 2024
Sedation is suggested for those who are very anxious when it comes to dental treatment. Midazolam is usually the agent we use and that can either be administered orally or intravenously (injection in the arm). This option relieves you of your anxiety and is safe for most people, however there is a residual affect throughout the day. It is strongly recommended that patients do not continue with their normal activity and a pick up after treatment is necessary. A careful assessment is required prior to any sedation being administered. As part of this you must list any medical conditions you have, and a full list of any medication or drugs that you may take, and any medical concerns or problems you may have. Your vital signs (blood pressure, pulse rate, oxygen concentration levels, expired CO2 levels) are monitored before and during the sedation. You will be carefully checked at the conclusion of this visit and then released to your pick up person – a responsible adult. 
A close up of a dental implant in a row of teeth.

Understanding Dental Implants

5 December 2024
A dental implant is a valuable and much more convenient alternative to replace your missing teeth. This involves placing a titanium implant into the bone where the root of the tooth was. This provides anchorage for a crown up the top. Dental implant is a significant advancement in dentistry over the last 40 years. Research shows that implants placed that long ago are still functioning well and are healthy. An implant nullifies the hassle of a removable denture in the mouth giving you a higher usability, aesthetic and confidence. This is a good option for those cases where teeth have either been extracted, lost due to complications from dental trauma or where the tooth has become weak to keep. There are certain criteria to see if an implant is a viable option for your case. The treatment option, its process and cost will be thoroughly discussed with you at the consultation appointment. 
A man is holding a pill in his hand and has a toothache.

Understanding Dental Trauma

5 December 2024
There are three dental structures that can be damaged from dental trauma: 1. The outermost layers of the tooth, namely the enamel and dentin. These may suffer a crack or break off completely. This is usually restored by your general dentist. 2. The innermost chamber of the tooth called the pulp may also get damaged and eventually die off. A pulpotomy is required in some cases and root canal treatment in others. 3. The surrounding structures of the tooth are the gums, bone and the periodontal ligament fibres (these hold your teeth in place), especially when the tooth is pushed out of its normal position. Careful repositioning of these teeth is required to give the tissues a good chance of recovering. These are sudden and often traumatic events that need to be dealt with as soon as possible to give the traumatised teeth the best chance of survival. Part of the cost could potentially be covered by ACC. Please download the free App called Knocked Out available on both Android and iphone in case of dental emergencies. 
A close up of a model of teeth with a red root.

Understanding Root Canal Treatment

5 December 2024
Root Canal Treatment  Sometimes the root canals are very fine, calcified or blocked. These can be difficult to access and an Endodontist has specialist equipment including an Operating Microscope. This treatment can be done over 1-2 appointments. The Endodontist will discuss this and the cost with you during your consultation appointment. If the root canals are not able to be cleaned completely they can become infected causing an abscess at the end of the root. The tooth is carefully examined prior to treatment to assess this risk. The added risk is the strength of the tooth following root canal treatment. The structure of the dentine changes with the collagen component becoming weaker. The sides of a posterior tooth are at risk of fracturing following root canal treatment and added protection is needed. Often a crown is required which is done by your General Dentist, however a 6-12 month observation period is suggested before this is done to check that the treatment has been successful. A tooth that has had root canal treatment is not as strong as a vital tooth. The structure of the dentine becomes weaker due to the breakdown of collagen with the dentine and this weakening effect becomes more pronounced with time. The average life of a root filled tooth is around 12 years. This can be improved by ensuring all of the root canals have been cleaned and filled, as well as protecting the crown (chewing surface) of the tooth. Sometimes a vertical crack may develop in the root of a root filled tooth which is related to the weakening of the dentine. There is no treatment other than extraction for these vertical root fractures.
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