If root canal treatment hasn't fully resolved an infection, or isn't a viable option for a particular tooth, your dentist may refer you for an apicectomy. Here's what the procedure involves and why it's sometimes the best way to save a tooth that would otherwise need extraction.
An apicectomy (also called root-end surgery, apical surgery or surgical endodontics) is a minor surgical procedure to remove infected tissue from around the tip (apex) of a tooth root, along with the very end of the root itself. It's typically used when a tooth has previously had root canal treatment, but infection persists at the root tip and can't be resolved through conventional means.
Several factors can lead to ongoing infection at the root tip even after root canal treatment:
In these situations, redoing the root canal treatment from above the tooth may not fully resolve the problem, but accessing the root tip directly through the gum can.
An apicectomy is carried out under local anaesthetic (with sedation available if needed) and typically involves:
The procedure usually takes between 45 and 90 minutes, depending on the tooth involved and the complexity of the case.
Apicectomies are most often carried out on front teeth and premolars, where root anatomy tends to be more accessible. Molars can also be treated, though the anatomy is often more complex, and case-by-case assessment determines suitability.
No, quite the opposite. An apicectomy is specifically a tooth-saving procedure, aiming to resolve infection while keeping your natural tooth in place, rather than proceeding to extraction. For many patients, it's the option that avoids the need for an implant or bridge to replace a lost tooth.
Recovery is generally similar to a surgical extraction: some swelling and discomfort for a few days, manageable with over-the-counter pain relief. Stitches, if non-dissolving, are typically removed after around a week. Most patients return to normal activities within a few days, though full healing of the bone around the root tip takes longer, often several months, and is checked with a follow-up X-ray.
Apicectomy has a good long-term success rate when carried out on an appropriately selected tooth, particularly when performed with specialist surgical technique and modern imaging to plan the approach precisely. That said, no dental procedure carries a 100% guarantee, and we'll discuss the realistic prognosis for your specific tooth as part of your consultation.
Whether an apicectomy is appropriate depends on factors including the tooth involved, root anatomy, the extent of infection, and the condition of the tooth overall. A detailed assessment, usually including imaging, allows us to give you an honest recommendation, including discussing extraction as an alternative where that's genuinely the better option.
Been referred for an apicectomy, or concerned about a tooth with a history of root canal treatment? Book a consultation with our specialist team.
This article is written for general information and does not replace individual clinical advice. Please consult our specialist team or your own dentist about your specific circumstances.
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