Apicoectomy
Microsurgical treatment of the root tip to resolve stubborn infection.
Sometimes infection or inflammation lingers at the very tip of a tooth's root even after a root canal, or the anatomy makes a conventional retreatment impossible. When that happens, an apicoectomy, also called endodontic microsurgery, can save the tooth.
Working through a small opening in the gum and under a surgical microscope, we treat the infection directly, remove the very tip of the root, and place a tiny seal to close the canal. Because it is done with magnification and gentle technique, the procedure is precise, minimally invasive, and most patients recover quickly.
Signs you may need this
If any of these sound familiar, it's worth having the tooth evaluated. Early care usually means a simpler, more comfortable result.
Why see an endodontist for this
An apicoectomy is microsurgery. It is performed through an opening a few millimetres across, at the tip of a root that sits inside bone, using instruments designed for exactly that. It is squarely specialist work and it is part of endodontic residency training.
Modern technique bears very little resemblance to the root-end surgery of thirty years ago. Magnification, ultrasonic root-end preparation, and biocompatible sealing materials have made it a precise, predictable procedure with far less trauma and much faster healing.
It is usually the last option before extraction, which is a good reason to have it done by someone who performs it regularly.
What this treatment does for you
Reaches what root canals can't
Treats infection at the root tip and the surrounding bone directly.
Minimally invasive
A small, precise opening under the microscope means gentler treatment and faster healing.
Saves the tooth
Often the final option to keep a tooth before extraction is considered.
Your visit, step by step
Plan with 3D imaging
A 3D scan shows the exact position of the root tip and the infection so treatment is precise.
Comfortable numbing
The area is fully numbed. Sedation options are available if you'd prefer to be more relaxed.
Treat the root tip
Through a small opening in the gum, the infected tissue and the tip of the root are removed under the microscope.
Seal & close
A tiny filling seals the end of the canal and the gum is closed with fine sutures to heal.
What we use, and why it matters
The equipment is the reason modern endodontics looks nothing like its reputation.
Surgical operating microscope
Lets the root end be inspected directly, which is how fractures and missed canals are found at the tip.
Cone beam 3D imaging
Maps the exact position of the root tip relative to the sinus and nerve before any incision is made.
Ultrasonic root-end preparation
Prepares a clean, precisely aligned cavity in the root tip without weakening the remaining root.
Biocompatible root-end filling
Modern mineral-based cements seal the canal end and encourage the surrounding bone to heal.
Microsurgical instruments and sutures
Fine instruments and very fine sutures mean a smaller opening and a neater, quicker recovery.
What happens afterwards, and when
A realistic timeline so you know what is normal and what is worth a phone call.
First 24 hours
Use an ice pack on and off and rest. Swelling is normal and is largely prevented by taking it easy on day one.
Days 2 to 3
Swelling and bruising typically peak, then start to fade. This is the point people worry; it is expected.
Days 5 to 7
Sutures are removed or dissolve. Most people are back to normal eating by now.
Weeks 2 to 4
The gum has healed over and the site looks unremarkable.
6 to 12 months
A review x-ray shows new bone filling the area where the infection was. That is the result we are after.
Aftercare & healing
A few simple steps help you heal comfortably and protect the result. We send you home with clear instructions and stay reachable if you have questions.
- Use an ice pack and rest for the remainder of the day to limit swelling.
- Mild soreness and swelling for a day or two is normal and managed with the medication we recommend.
- Eat soft foods and avoid the surgical area while it heals.
- Sutures are removed or dissolve within about a week; we'll see you for a quick check.
What happens if it is left
Persistent infection at a root tip is a low-grade, ongoing process. It is easy to live with and easy to ignore, and it keeps going.
- The lesion at the root tip slowly enlarges and destroys more of the surrounding bone.
- Recurrent flare-ups of pain, swelling, and drainage tend to become more frequent over time.
- Losing bone around the root reduces what is available later for an implant.
- The tooth eventually needs to be extracted, having spent years as a low-level source of infection.
Cost & insurance
The fee for endodontic microsurgery reflects the surgical time, the 3D planning, and the materials used to seal the root end.
Most plans that cover endodontics cover apicoectomy, often at a surgical benefit level. We verify your coverage and give you the estimate before scheduling.
Set against extraction plus an implant, crown, and the months of treatment that involves, saving the tooth is usually both cheaper and quicker.
We go through the estimate and your coverage with you before treatment starts, not after. If the number is a problem, say so and we will talk about options.
Ask about costCommon questions
No. It's a short, precise microsurgical procedure done with local anesthesia. Most patients return to normal activity within a day or two.
Mild soreness and some swelling for a day or two is typical. We provide clear aftercare instructions and are available if you have questions.
An apicoectomy lets you keep your natural tooth. Extraction followed by an implant or bridge is more involved and more costly over time.
The area is fully numbed with local anesthetic. If you'd prefer to be more relaxed, we can discuss sedation options.
Endodontic microsurgery has a high success rate, particularly with the 3D planning and microscope-guided technique we use.
In pain, or not sure if you need apicoectomy (microsurgery)?
Request a visit and our team will help you figure out the next step. No referral needed to be seen.