Your Guide to Apicectomy
What an apicectomy is, why you may need one when root canal treatment has not fully cleared an infection, and what happens.
Urgent help: who to contact
Call 999 or go to A&E now if, after an apicoectomy, you get a lot of swelling spreading to your neck or eye area, or you find it hard to breathe or swallow.
Contact your dental team if you develop a high temperature (above 38°C). If you cannot reach them, call NHS 111.
What is an apicectomy?
An apicectomy is a minor operation. The tip of the tooth root (the apex) is removed, along with any infected tissue around it. A small filling is then placed in the end of the root to seal it.
It is sometimes spelt apicoectomy. It is also called periradicular surgery or root-end surgery.
It is done when a tooth has already had root canal treatment but still shows signs of infection or has not healed. It is used when this cannot be fixed by redoing the root canal treatment through the tooth in the usual way.
Why might I need an apicectomy?
You may be offered an apicectomy when:
- An infection or cyst around the root tip has not cleared after root canal treatment
- The root canal cannot be redone through the top of the tooth. For example, you may have a post and crown that would be very hard to remove without damaging the tooth.
- The root canals are too complex, or too blocked by hard tissue (calcified), to reach from the top of the tooth
- You still have pain or swelling, even though the root canal treatment was done well
What other options do I have?
- Redoing the root canal treatment (retreatment). The dentist goes back in through the top of the tooth to clean and seal the root canals again. This is always considered first, if it can be done.
- Taking the tooth out (extraction). If neither retreatment nor an apicectomy is suitable, removing the tooth ends the infection. You would then need to think about replacing the tooth.
- No treatment. This is not advised for an active infection. An infection at the root tip that does not go away can spread. In rare cases, it can become serious.
What happens during an apicectomy?
An apicectomy is done with a numbing injection (local anaesthetic), usually in the dental chair:
- The area around the tooth is fully numbed.
- A small cut is made in the gum to show the bone over the root tip.
- A small amount of bone is removed to reach the root tip.
- The infected tissue around the root tip is removed. The root tip itself (about 3mm) is removed too.
- The very end of the root canal is cleaned and sealed with a small filling (a retrograde filling).
- The cut is stitched closed.
The operation usually takes 45–90 minutes. This depends on where the tooth is and how complex it is.
Risks and possible complications
Common:
- Swelling, bruising and soreness around the area for 3–7 days
- Mild bleeding from the cut
Uncommon:
- Infection that needs antibiotics
- The treatment does not work. The infection does not clear, and the tooth may need to come out in the end.
- Slow healing
Rare:
- Nerve damage. This can cause numbness of the lip, chin or cheek. It may be temporary or, very rarely, permanent. This matters most for lower front teeth and premolars, where a nerve (the mental nerve) is close.
- Damage to the root of a nearby tooth
- An opening into the sinus (upper teeth only)
Overall, an apicectomy works in about 85–90% of cases when done by an experienced clinician.
After your apicectomy
- Take the painkillers you have been advised to take for the first 48–72 hours.
- Hold a cold pack on the outside of your face for the first few hours.
- Eat soft foods on the other side.
- Do not disturb the stitches.
- Avoid hard exercise for 48–72 hours.
- Stitches are usually taken out after 1–2 weeks.
- You will have a follow-up X-ray at 6–12 months. This checks that the bone around the root tip has healed.
Questions to ask your dental team
- Why are you advising an apicectomy instead of redoing the root canal treatment?
- How likely is it to work in my case?
- What risks come from where my tooth is?
- If the apicectomy does not work, what would happen next?
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 dental team about your individual options, risks, and treatment plan. Treatment outcomes vary between patients depending on individual circumstances. Your dental team will confirm exact fees and what is suitable for your specific circumstances before you agree to any treatment.
Sources
- A guide to Good Endodontic Practice, 1st edition. British Endodontic Society, 2022.
- Apicectomy. Oral Health Foundation.
Links checked 18 October 2026.
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For clinicians: Apicoectomy (Periradicular Surgery) notes template.
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