What Is an Apicoectomy?
An apicoectomy is an endodontic surgery that targets the very tip of the tooth root, called the apex. The endodontist makes a small incision in the gum, removes the infected tissue around the root tip, and places a root end filling to seal the root canal. This endodontic treatment is also called root-end surgery or periradicular surgery.
After a root canal procedure, bacteria sometimes persist in tiny canal branches near the root tip that instruments cannot reach from inside the tooth. When infection remains despite endodontic treatment, it can threaten your oral health. An apicoectomy approaches the problem surgically, removing the source of infection and placing a root end filling to prevent bacteria from re-entering.
When Is Endodontic Surgery Needed?
An apicoectomy is not a first-line treatment. Your endodontist will recommend this endodontic surgery only after a root canal procedure or retreatment has not healed, or when retreatment is not possible because a post, crown, or complex anatomy blocks access. A biopsy of infected tissue near the root tip may also require endodontic surgery. Among dental procedures for saving compromised teeth, apicoectomy has some of the high success rates in the field.
Apicoectomy Procedure: What to Expect
This endodontic surgery is performed in the endodontist's office. The entire procedure takes 30 to 90 minutes depending on the tooth.
During the Endodontic Surgery
Your endodontist takes 3D images (cone-beam CT) beforehand to plan the approach. On the day of surgery, the area is numbed with a local anesthetic. You will be awake but should not feel pain. A small incision is made in the gum to expose the bone, and a tiny window is created to access the root tip.
Using a surgical microscope, the endodontist removes approximately 3 millimeters of the root tip along with any infected tissue surrounding it. The end of the root canal is cleaned with ultrasonic instruments and sealed with a root end filling, typically mineral trioxide aggregate (MTA). The gum is sutured closed. If you have dental anxiety, ask about sedation options such as nitrous oxide. A local anesthetic alone keeps most patients comfortable during these dental procedures.
Recovery and Success Rates
Recovery from endodontic surgery is typically faster than patients expect. Most people return to normal activities within the first few days after the procedure.
Recovery Timeline
During the first few days, apply ice packs for 20 minutes on and 20 minutes off to reduce swelling. Take pain medication as directed. Eat soft foods and avoid chewing near the site. Swelling peaks around day 2 or 3 and then improves. Sutures come out at a follow-up visit 5 to 7 days after the endodontic surgery. Soft tissue heals in 1 to 2 weeks, but full bone regeneration around the root tip takes several months. Follow-up X-rays at 6 and 12 months confirm healing.
High Success Rates
Modern endodontic surgery has high success rates. Studies report outcomes from 85% to 97% when surgical microscopes, ultrasonic instruments, and biocompatible root end filling materials are used. Front teeth and premolars tend to have higher success rates than molars. Success means the infected tissue is eliminated, bone heals, and the tooth stays functional. Among dental procedures aimed at saving natural teeth, apicoectomy is one of the most reliable. Protecting your oral health by keeping a natural tooth avoids the need for implants or bridges.
Cost and When to See an Endodontist
An apicoectomy typically costs $900 to $1,900 per tooth. Front teeth are at the lower end; molars cost more due to multiple roots and harder access. Most dental insurance plans cover endodontic surgery at 50% to 80% after the deductible. Contact your insurer for specific benefit details.
If you have a tooth that still has symptoms or shows infection on X-rays after a root canal procedure, ask your dentist for a referral to an endodontist. The endodontist will determine whether retreatment, endodontic surgery, or extraction best protects your oral health. Many endodontists accept self-referred patients and offer same-day consultations.
Find an Endodontist Near You
If your endodontist has recommended an apicoectomy or you need a second opinion on endodontic treatment, search our directory. Every endodontist on My Specialty Dentist has verified specialty credentials. Find an endodontist in your area and schedule a consultation.
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