An apicoectomy, also called root-end surgery, is a minor surgical procedure that removes the very tip of a tooth root along with any infected tissue around it. It is used to save a tooth when a previous root canal has not fully healed and the infection keeps coming back. With modern equipment, an apicoectomy done as endodontic microsurgery has a reported success rate of around 92 to 94 percent, far higher than the 40 to 60 percent seen with older techniques. That improvement is the main reason it is now a routine way to keep a tooth that would otherwise be removed.
Key takeaways
- An apicoectomy removes the root tip and seals the end of the canal from the outside.
- It is considered when a root canal or retreatment has not cleared infection at the root tip.
- Modern microsurgery raises success from around 59 percent to about 94 percent.
- It is a small procedure done under local anaesthetic, usually taking 30 to 90 minutes.
- Saving the natural tooth is often preferable to removing it and replacing it with an implant or bridge.
Why a root canal sometimes needs surgery
Most root canals heal well, but a small number leave infection behind at the tip of the root, often in a canal that was too narrow or curved to clean fully from inside the tooth. When that happens, the first choice is usually root canal retreatment, where the dentist reopens the tooth and cleans the canals again. If retreatment is not possible or has already been tried, an apicoectomy approaches the problem from the other end, going in through the gum to treat the root tip directly. It is also used when a post and crown make reopening the tooth risky.
What happens during the procedure
The tooth and gum are numbed with local anaesthetic, so you should feel pressure but not pain.
Step 1: Access the root tip
A small opening is made in the gum near the root, and a tiny amount of bone is removed to reach the infected tip.
Step 2: Remove the tip and infection
The last few millimetres of the root are removed along with the surrounding inflamed tissue.
Step 3: Seal the canal from the end
The end of the canal is cleaned and sealed with a biocompatible filling material such as MTA to stop bacteria re-entering.
Step 4: Close the gum
A few small stitches close the gum, and healing begins over the following weeks.
Success rates and how it compares
| Approach | What it involves | General success rate | Best when |
|---|---|---|---|
| Root canal retreatment | Reclean canals from inside the tooth | Around 74 to 85 percent | The tooth can be reopened safely |
| Apicoectomy (microsurgery) | Treat and seal the root tip from outside | Around 92 to 94 percent | Retreatment is not possible or has failed |
| Extraction and replacement | Remove the tooth, then implant or bridge | High, but loses the natural tooth | The tooth cannot be saved |
Recovery and aftercare
Most people return to normal activity the next day. Some swelling and mild discomfort for two to three days is normal and is managed with over-the-counter pain relief and a cold compress. You keep the area clean with gentle rinsing, and stitches are usually removed or dissolve within a week. Healing of the bone underneath continues quietly for several months, and the dentist checks progress with an X-ray at a later review. Keeping a natural tooth this way avoids the cost and time of removing it and replacing it, which you can compare in our guide to implants versus bridges versus dentures.
Frequently asked questions
Is an apicoectomy painful?
The procedure itself is done under local anaesthetic and is not painful. Afterwards there is usually mild soreness for a couple of days that responds well to simple pain relief.
How long does the surgery take?
For a single tooth it usually takes 30 to 90 minutes depending on which tooth and how accessible the root is.
Will the tooth be as strong afterwards?
Removing a few millimetres of root tip does not usually weaken a tooth that has a healthy remaining root and a good crown or filling.
What if the apicoectomy does not work?
If infection persists, options include repeating the surgery in some cases or removing the tooth and replacing it. A dentist will discuss the odds for your specific tooth beforehand.
Is it better than pulling the tooth?
Keeping your own tooth is usually preferable when the odds are good, because natural teeth function and feel better than any replacement. The dentist weighs the tooth's condition before recommending surgery.
If a treated tooth keeps flaring up, it is worth having it assessed before the problem spreads. Book a review and see current options on our offers page, or read about the earlier option of saving versus removing a tooth.
