What is an apicoectomy — and why might you need one?
Most endodontic problems are solved from the crown of the tooth downward: through the opening at the top, we clean, shape, and seal the canals. An apicoectomy is a surgical approach from the opposite direction: through a small incision in the gum tissue, directly at the root tip.
It becomes the right choice when:
- The canals are obstructed by a post, separated instrument, or calcification that can't be bypassed from above
- A persistent infection around the root tip hasn't resolved despite previous treatment or retreatment
- The root tip has an unusual anatomy — an extra canal branching off the very end — that standard treatment can't reach
- A root fracture or calcium deposit has formed at the apex and must be removed
The procedure, step by step
We begin with local anesthesia and, once you're fully comfortable, a small incision in the gum tissue alongside the tooth. We gently fold the tissue back and access the tip of the root through the underlying bone. A few millimeters of the root tip — the apical portion — are removed, along with any infected tissue in the surrounding bone.
Under the surgical microscope, we inspect the cut surface of the root for cracks, additional canals, or incomplete seals, and clean the root-end cavity. A small filling is then placed to seal the root from the bottom. The gum tissue is repositioned and closed with sutures, which are typically removed at a brief follow-up visit one week later.
Healing takes place over the following months as bone regenerates around the site. A follow-up X-ray at six and twelve months confirms the infection has resolved and bone has filled in.
What to expect after surgery
The day of surgery: rest, ice the outside of your face in 20-minute intervals, avoid strenuous activity. Take over-the-counter pain relievers as directed — most patients manage well on ibuprofen or acetaminophen. Avoid rinsing or spitting vigorously for 24 hours.
The next one to three days: mild swelling and bruising around the area is normal and gradually improves. Most patients return to desk work the following day. Soft foods and gentle care around the surgical site for about a week. You'll leave with written post-op instructions specific to your case and a direct number to call if you have questions.
Common questions
Is it painful?
The procedure is performed under local anesthesia — you won't feel it happening. Post-operative discomfort is typically mild to moderate and well-managed with over-the-counter medications. Most patients describe it as less uncomfortable than they expected.
How is an apicoectomy different from retreatment?
Retreatment works from the top of the tooth down through the canals. An apicoectomy works from the bottom up, through the gum and bone directly at the root tip. They address different problems and are sometimes done together in sequence.
How long does healing take?
Sutures come out after about a week. The site feels normal within two to three weeks. Bone regeneration, which we confirm on follow-up X-rays, takes several months — but this happens on its own without intervention on your part.
For more on what to expect at your visit, see our Patient Information page. If you're wondering whether an apicoectomy or retreatment is the right path, we'll walk through the imaging with you at your consultation.