Understand what an apicoectomy is, why it may be needed when root canal treatment has not fully resolved an infection, and what the procedure involves.
An apicoectomy (also called periradicular surgery or root-end surgery) is a minor surgical procedure to remove the tip of the tooth root (the apex) along with any infected tissue around it. A small filling is then placed in the end of the root to seal it.
It is carried out when a tooth that has already had root canal treatment continues to show signs of infection or failed healing that cannot be resolved by conventional retreatment through the tooth.
Why might I need an apicoectomy?
An apicoectomy may be recommended when:
A persistent infection or cyst around the root tip has not resolved after root canal treatment
A root canal cannot be retreated through the crown of the tooth — for example, because of a post and crown that would be very difficult to remove without damaging the tooth
The root canal system is too complex or calcified to be reached from the top of the tooth
There is persistent pain or swelling despite technically satisfactory root canal treatment
What are my alternatives?
Conventional root canal retreatment — re-entering the tooth through the crown to re-clean and reseal the root canals. This is always considered first if technically possible.
Tooth extraction — if neither retreatment nor apicoectomy is appropriate, removing the tooth ends the infection. Tooth replacement would then need to be considered.
No treatment — not advisable for an active infection. Persistent apical infection can spread and, in rare cases, become serious.
What does the procedure involve?
An apicoectomy is carried out under local anaesthetic, usually in the dental chair:
The area around the tooth is numbed thoroughly
A small incision is made in the gum to expose the bone over the root tip
A small amount of bone is removed to gain access to the root tip
The infected tissue around the root tip and the root tip itself (approximately 3mm) are removed
The root canal at the very end of the root is cleaned and sealed with a small filling material (a retrograde filling)
The incision is sutured closed
The procedure usually takes 45–90 minutes depending on the tooth's position and complexity.
Risks and possible complications
Common:
Swelling, bruising, and soreness around the area for 3–7 days
Mild bleeding from the incision site
Uncommon:
Infection requiring antibiotics
Failure of the procedure — the infection does not resolve and extraction may ultimately be needed
Delayed healing
Rare:
Nerve damage causing temporary or, very rarely, permanent numbness of the lip, chin, or cheek (particularly relevant for lower front teeth and premolars where the mental nerve is close)
Damage to the root of an adjacent tooth
Communication with the sinus (upper teeth only)
Overall success rates for apicoectomy are approximately 85–90% when carried out by an experienced clinician.
After your apicoectomy
Take recommended painkillers for the first 48–72 hours
Apply a cold pack to the outside of your face for the first few hours
Eat soft foods on the opposite side
Do not disturb the sutures
Avoid strenuous exercise for 48–72 hours
Sutures are usually removed after 1–2 weeks
A follow-up X-ray will be taken at 6–12 months to check healing of the bone around the root tip
Questions to ask your dentist
Why is an apicoectomy being recommended over retreatment of the root canal?
What is the likelihood of success in my particular case?
What are the risks specific to the position of my tooth?
If the apicoectomy fails, what would the next option be?
This leaflet is for general information only and does not replace professional dental advice. It is intended to support — not replace — the discussion with your dentist about your individual options, risks, and treatment plan. Treatment outcomes vary between patients depending on individual circumstances. Your dentist will confirm exact fees and what is suitable for your specific circumstances before you agree to any treatment.
When to Seek Urgent Help
If you develop significant facial swelling, difficulty swallowing, or a high temperature after an apicoectomy, go to A&E immediately or call 999.
References
Aligned with guidance from: British Endodontic Society, FGDP(UK), SDCEP.