Retreatment or Apicoectomy? Deciding in East Finchley

Choosing between retreatment and an apicoectomy depends on why the first root canal failed. A 3D CBCT scan is essential for an accurate diagnosis, which we perform here in our Finchley practice. Root canal retreatment is usually the first choice when the problem lies inside the tooth’s canal system. This suits issues like missed canals from the original treatment, new decay that has reached the tooth, or a leaking filling that lets bacteria re-enter. It is effectively a redo of the original root canal, but with a dental operating microscope for higher precision. An apicoectomy, a minor surgical procedure, is selected when the infection sits at the tip of the root and cannot be reached from inside the tooth. This happens with a cyst, a fractured root tip, or complex anatomy like a sharply curved root. It is also preferred if the tooth has a well-fitting post and crown, as retreatment would require removing this restoration and could damage the tooth.

A patient from Muswell Hill came to us with a throbbing pain in a molar that had a root canal years ago. A 3D scan showed a tiny fourth canal that was missed during the initial procedure and had become infected. Because the issue was accessible from within the tooth and the existing crown could be saved, we recommended retreatment. The procedure took 90 minutes, and by cleaning and sealing the missed canal, we resolved his pain completely.

First we access the inside of the tooth, often through the existing crown, which takes about 15 to 20 minutes. Next, using a dental microscope, we remove the old filling material, disinfect the canals, and look for untreated anatomy. This cleaning phase lasts around 60 to 90 minutes. Finally we refill and seal the canals and place a temporary filling. The entire procedure takes one appointment of about 90 to 120 minutes.

This procedure takes a different route as we approach from the outside. First we numb the area. Then a small incision in the gum provides access to the root tip, taking about 10 minutes. The infected tissue and the end of the root tip are removed. A small filling seals the end of the root, and the gum closes with a few stitches. An apicoectomy usually lasts between 60 and 90 minutes.

Recovery from a retreatment is very similar to an original root canal. You might feel some tenderness for a few days, easily managed with over-the-counter painkillers like ibuprofen. An apicoectomy involves more post-operative care because it is a surgical procedure. Expect some swelling and bruising for 3-5 days, which can be managed with ice packs. Stitches are typically removed after a week. Success rates for both are high when performed correctly. Non-surgical retreatment has a success rate of around 75-85%. An apicoectomy, when indicated, has a success rate often exceeding 90% because it directly removes the source of infection at the root's apex. Long-term care for both involves good oral hygiene and regular dental check-ups.

A 45-year-old from Golders Green had a persistent pimple on her gum above a front tooth. The tooth had a large structural post and a cosmetic crown. A 3D scan revealed a cyst at the root tip. Retreatment would have meant destroying the expensive crown and risking tooth fracture while removing the post. An apicoectomy allowed us to resolve the infection surgically in one 75-minute visit, completely preserving the existing restoration. She was back to work the next day with minimal discomfort.

As a private practice in Finchley, we provide fully transparent cost estimates before any treatment begins. The cost for retreatment or an apicoectomy can vary significantly based on the tooth's complexity and location (molars are more difficult than front teeth). Generally, prices for these advanced procedures range from £800 to £1,500. An apicoectomy may sometimes be more expensive due to its surgical nature. Your fee will include all necessary 3D CBCT scans and follow-up appointments, with no hidden fees. We accept private dental insurance from providers including Max Bupa, Denplan, and Cigna and can help you with the paperwork.

To choose what's right for you, it's important to ask detailed questions, whether you consult with us or another practice in North London: 1. Why has my original root canal failed? 2. Do you use a dental microscope and 3D CBCT scanning for diagnosis and treatment? 3. Based on my scan, why are you recommending one procedure over the other? 4. What is your success rate with this specific procedure? 5. What is the full cost, including scans and follow-up visits? 6. What are the risks if I choose not to have either treatment? 7. What experience do you have in performing complex retreatments and apicoectomies?