Dr. Shreyas Oza is a highly skilled Specialist Endodontist at Endodontic Associates of Arlington, Dallas, Texas. Dr. Oza, a Diplomate of the American Board of Endodontics, holds a Doctor of Dental Surgery degree from the University of California, San Francisco, and a Master of Science in Dentistry. He also holds a specialty certificate in Endodontics from the University of the Pacific, San Francisco. With a special interest in 3D printing, restorative dentistry, and cutting-edge technology, Dr. Oza is dedicated to providing top-notch endodontic care. Beyond his clinical practice, he is passionate about iPhone photography and enjoys exploring Dallas's culinary delights with his wife, a fellow dentist.
In Part-3 of the interview, we discuss apicoectomy, dental emergencies, and much more!
M. Subha Maheswari: Upon reviewing your profile, we saw that apicoectomy is one of your specialties. Could you explain what an apicoectomy is for our readers? How do you determine when necessary, and what factors contribute to its success?
Dr. Shreyas Oza: An apicoectomy, as the name suggests, involves the removal of the apex of a tooth's root. It is typically performed when a root canal has failed for various reasons. For example, if there is a separate instrument inside the canal, it can act as a blockage. If retreatment is attempted, the instrument might prevent access to the bacteria residing at the apex. Similarly, if retreatment appears successful but the tooth continues to get infected, anatomical challenges could be the cause.
For instance, if two adjacent canals have microscopic webbing between them, bacteria may persist in areas that instruments cannot reach. In such cases, an apicoectomy may be required to access and seal the affected area effectively. Sometimes there might be a cyst or an extraradicular infection that a conventional root canal won’t be able to address. Iatrogenic issues can also necessitate this procedure—for example, if a canal has a curve but a previous clinician inadvertently instrumented it straight, leaving an uncleanable portion. While it may be possible to correct such an error with the right skills and magnification, it is a highly challenging and not always successful process. In such cases, an apicoectomy might be the best option.
To summarize, an apicoectomy is indicated when there is a persistent infection due to anatomical factors, extra-radicular infection, blockages from separated instruments, or when retreatment would require destroying an existing crown or post. For instance, in a front tooth with a compromised top half, drilling out the restoration would further weaken the tooth, making an apicoectomy a more viable option.
Modern apicoectomy, also known as endodontic microsurgery, involves lifting the gum tissue, drilling a small hole into the bone to access the root end, removing 3mm of the root under magnification, and checking for cracks or fractures. Ultrasonic instruments are then used to clean the root interior, typically for 3-6mm, followed by sealing with bioceramic putty, MTA, or another suitable retrofilling material. This process prevents infection and endotoxins from re-entering the bone.
The difficulty of an apicoectomy varies—procedures on front teeth are generally simpler, while cases involving the palatal root of a maxillary molar can be more complex. Success rates depend on multiple factors, including the clinician’s surgical skill, whether prior retreatment was attempted, and the patient’s age and medical history among several other factors. If a root canal has been present for a long time and retreatment has already reduced bacterial load, the success rate of an apicoectomy is higher. On the other hand, simply cutting the root end without proper retreatment significantly reduces success.
Microsurgery improves outcomes—when ultrasonic retro-preparation and bioceramic sealing are used, success rates exceed 90%. However, if only the root end is cut without additional measures, the success rate drops below 50%. The use of magnification is crucial for detecting cracks and fractures. Age also plays a role—young patients tend to have better outcomes than older patients. While gender is not a major factor, multiple variables influence success, with technique and clinician expertise being critical components.
M. Subha Maheswari: We briefly touched on dental emergencies earlier. Could you share the most common dental emergencies you encounter in your clinic? Additionally, how do you educate your patients on preventing such emergencies?
Dr. Shreyas Oza: The most common dental emergency we see is severe tooth pain—patients reporting pain at a 10/10 level, unable to sleep for days. Once the pain reaches this stage, immediate intervention is necessary, usually by numbing the patient and performing a root canal.
For temporary relief, a combination of 600mg of ibuprofen and 1000mg of acetaminophen taken simultaneously has been shown to provide excellent analgesic effects. However, when a patient reaches this stage, it usually means they have neglected their dental health.
I use these cases as teaching moments. I remind my patients that if they want to avoid this kind of pain in the future, they should visit their dentist every six months, brush at least twice daily, and, most importantly, brush before sleeping with fluoride toothpaste. The pain serves as a powerful reminder, and they rarely want to experience it again.
Dr. Chhavi Garg: I am not from a dental background, but as someone fearful of dental visits and procedures throughout my childhood, my question is for that demographic. What are the most common endodontic procedures you see in children, and how are they different from what you typically do for adults?
Dr. Shreyas Oza: This varies from region to region. In my office, we frequently see children with large cavities that have already reached the nerve. Depending on the child's age and whether the roots are fully developed, the treatment approach differs. If the roots are completely formed, we perform a standard root canal procedure. If they are not, and depending on which tooth is affected, we may opt for regenerative endodontics. In this procedure, we disinfect the area, place medication to control bacteria, and at a subsequent visit, induce bleeding and apply specific medications to stimulate root-end formation.
A major challenge with pediatric cases is ensuring follow-up visits. If parents do not bring their child back at the required intervals, treatment failure may occur. In cases where follow-up is unlikely, we can perform apexification, a procedure to create an artificial root-end closure. It is a well-established treatment method.
Surprisingly, some of my best patients are children. The most common procedure remains the root canal, but we also manage traumatic injuries—falls, sports injuries, or accidents that chip teeth. Treatment for such injuries depends on the type of trauma. There’s an entire day's worth of lectures dedicated to this in training, so I won’t go into too much detail. However, treating children presents unique challenges due to their transitioning dentition.
Dr. Chhavi Garg: Continuing with that, what key advice would you give parents to maintain their children's dental health?
Dr. Shreyas Oza: Make sure they brush their teeth at night before sleeping and avoid eating afterward. That is the best advice I can give for any age group. Whether or not they floss, they must brush with toothpaste before bed. Morning brushing is optional, but night-time brushing is non-negotiable.
I explain it to my patients this way: if you left food out at 37 degrees Celsius for 8-10 hours overnight, would you eat it the next morning? Of course not—it would be teeming with bacteria. The same thing happens in your mouth. Do you want food rotting between your teeth? This analogy is usually convincing because the thought of food decomposing in the mouth is quite disgusting. That disgust works in our favor!
Dr. Chhavi Garg: If something does go wrong, what should parents watch out for? Are there any specific signs of trouble?
Dr. Shreyas Oza: Yes. In endodontics, I always tell my patients to look for three key warning signs:
Pain at night that wakes the child up.
Pain with hot or cold foods that linger after exposure. For example, if a child drinks ice-cold water and experiences throbbing pain that persists after swallowing, that’s a concern.
Spontaneous pain—when the tooth starts hurting without any trigger.
These signs indicate that the nerve inside the tooth is inflamed and not recovering. In endodontic's terms, this condition is called ‘Symptomatic Irreversible Pulpitis.’ Once the nerve reaches this stage, there are only two options: a root canal or extraction. This can often be accompanied with pain on chewing which is a common complaint from children as well.
In rare cases, a tooth may bypass this painful phase entirely, and the nerve simply dies. A child might have a large cavity without ever experiencing pain, but then suddenly develop swelling or a pimple-like bump on the gum. Swelling indicates an acute abscess, while a gum pimple suggests a chronic apical abscess—both of which require endodontic treatment.
For parents, the key takeaway is to watch for any of these three warning signs. If their child complains of night pain, lingering sensitivity to temperature changes (not necessarily sweets or spicy foods), or spontaneous pain, it’s time to see a dentist.
Dr. Chhavi Garg: That’s really helpful. I’m sure our readers will benefit from this. One last question—what advice would you give to young professionals aspiring to become endodontists?
Dr. Shreyas Oza: If you love it, do it. That applies to any specialty. Don’t pursue it just for the prestige, even though it does carry prestige with the MDS qualification. Specialization should be about contributing to the field, not just benefiting from it. Endodontics is challenging but rewarding.
In India, you have the flexibility to practice multiple aspects of dentistry without strict specialization constraints. In contrast, in the U.S., endodontists rely solely on referrals—if I started doing crowns here, I’d lose root canal referrals. So, only specialize if you genuinely enjoy the subject. If you prefer a broader scope of practice, general dentistry is also a great career path.
MedBound Times expresses sincere gratitude to Dr. Shreyas Oza for sharing his valuable insights on our platform.
