Apicoectomy (Surgical Root Procedure)

What is Apicoectomy?

When a tooth has already had a root canal but symptoms return, retreatment through the crown is usually the first option. In some cases, however, the source of the infection sits at the very tip of the root and cannot be reached or fully resolved from inside the tooth. Apical microsurgery, also called an apicoectomy, treats the problem from the outside, saving a tooth that would otherwise need to be extracted.

The procedure addresses a specific set of situations: a persistent infection at the root tip after a previous root canal, complex canal anatomy that cannot be accessed from inside the tooth, a post or crown that cannot be safely removed for retreatment, or a small fracture or cyst at the root end. Rather than reopen the tooth from the top, the endodontist accesses the root tip through a small incision in the gum, removes the infected tissue and the very end of the root, and seals the root end with a biocompatible filling material.

At San Diego Center for Endodontics, Dr. Freer and Dr. Adams perform apical microsurgery using a surgical microscope and 3D cone beam imaging. This combination matters. Modern microsurgical techniques have transformed what used to be an unpredictable last resort into a precise, well-tolerated procedure with strong long-term outcomes. Magnification and illumination allow the root end to be inspected and sealed with detail that was simply not possible a generation ago, and 3D imaging shows the surrounding anatomy, including nerves and sinuses, before the first incision is made.

The procedure itself is typically completed in a single visit under local anesthesia and takes about 60 to 90 minutes depending on the tooth. Most patients report no pain during surgery and only mild soreness or minor swelling for one to three days afterward, manageable with over-the-counter pain relief. A few small sutures close the gum, and most people return to normal activities the next day. Bone gradually fills in around the treated root over the following months, and healing is verified on follow-up X-rays.

Apical microsurgery is not the right answer for every tooth, and we will not recommend it unless the prognosis genuinely supports saving the tooth. When it is the right answer, it is often the difference between keeping your natural tooth and replacing it with an implant or bridge, and the natural tooth, almost without exception, is the better long-term outcome.