When is Apicoectomy Necessary? Your Questions Answered

If you’ve had a root canal but pain or infection persists, your endodontist might recommend a minor surgical procedure called an apicoectomy. This guide explains when it’s necessary, how it’s performed, and what to expect during healing.

Understanding Tooth Root Anatomy

Your teeth are anchored into the jawbone by roots. Front teeth usually have one root, while premolars and molars may have two or more. The apex, or tip of each root, is where blood vessels and nerves enter the tooth, traveling through the root canal and into the pulp chamber inside the crown — the visible part of the tooth.

What is an Apicoectomy and Why Is It Done?

An apicoectomy may be recommended when infection or inflammation persists after root canal treatment or retreatment. During a root canal, the canals are cleaned and sealed. However, because root canal systems are highly complex and can contain tiny branches, it’s possible for infected tissue to remain — especially in hard-to-reach areas.

An apicoectomy involves removing the tip (apex) of the root along with the surrounding infected tissue. The end of the root is then sealed with a filling to prevent reinfection. This is often referred to as endodontic microsurgery because the procedure is typically performed under a surgical microscope.

When is Apicoectomy Necessary?

Apicoectomy is generally considered only after a tooth has undergone at least one root canal procedure. In many cases, endodontists will attempt retreatment first using advanced imaging to detect and address untreated canals. But when retreatment isn’t possible or has already failed, an apicoectomy may be the next best step to save your tooth.

Common reasons for recommending apicoectomy include:

• Persistent infection at the root tip
  
• Previous root canal failed to resolve symptoms
  
• Blocked or curved canals that prevent full retreatment access
  
• Small fractures or root-end cysts

Note: An apicoectomy is not the same as a root resection. In a root resection, the entire root is removed — not just the tip.

How to Prepare for an Apicoectomy

Before the procedure, you’ll meet with your dentist or — more commonly — an endodontist, who specializes in root canal surgery. You may have digital X-rays taken, and in some cases, be prescribed:

• Antimicrobial mouth rinse
  
• Anti-inflammatory medication
  
• Antibiotics

If you have high blood pressure or sensitivity to epinephrine, notify your provider. Local anesthesia for apicoectomy contains more epinephrine than typical dental anesthetics to minimize bleeding and improve visibility. It’s common to feel your heart race briefly after injection — this is normal and temporary.

What Happens During the Procedure

To access the root tip, your endodontist will make a small incision in the gum near the affected tooth and gently lift it away. The infected tissue and the final few millimeters of the root will be removed.

A small amount of dye may be applied to check for hidden cracks. If the tooth is fractured beyond repair, it may need to be extracted and the apicoectomy will not proceed.

The root-end canal is then thoroughly cleaned and sealed — usually using ultrasonic instruments under high magnification. This precise technique improves success rates and healing outcomes.

A final X-ray will be taken before the gum is sutured back into place.

Procedure Time:
Most apicoectomies take 30–90 minutes, depending on the tooth’s location and root structure. Front teeth are usually faster; molars, especially in the lower jaw, may take longer.

Apicoectomy Healing Stages and Aftercare

After surgery, your endodontist will give you detailed aftercare instructions. Here’s what to expect during recovery:

• First 24 hours: Apply ice packs intermittently and rest. Avoid brushing near the surgical area, rinsing vigorously, smoking, or eating crunchy foods.
  
• Day 2: Swelling may peak. Mild bruising and soreness are normal.
  
• Pain Management: Over-the-counter NSAIDs like ibuprofen typically control discomfort well.
  
• Stitches: Sutures are usually removed 2–7 days after the procedure.
  
• Healing Timeline: Most swelling and tenderness resolve within 10–14 days. Many patients report that apicoectomy recovery is easier than healing from the original root canal.
  

Avoid touching the area with your tongue or lifting your lip to examine it, as this can delay healing or disturb sutures.

Risks and Considerations

Your endodontist will review any potential risks during your consultation. The most common concern is that the procedure may not be successful, and the tooth might eventually need to be extracted.

Other location-specific risks include:

• Upper molars: Risk of sinus involvement. You may be prescribed antibiotics or decongestants.
  
• Lower molars: The roots are close to nerves, so there’s a small risk of temporary numbness. Advanced imaging helps your specialist avoid these structures safely.

Fortunately, complications are rare, and an apicoectomy is often a long-term, permanent solution for saving a tooth.

When to Call Your Dentist

If you’re experiencing pain, swelling, or sensitivity in a tooth that’s already had a root canal, it’s time to schedule a professional evaluation. Your general dentist can take X-rays and, if needed, refer you to an endodontist for an apicoectomy consultation.

If you’re in the Charlotte, NC area and facing root canal issues, the team at Ballantyne Endodontics is here to help. We use advanced imaging and microsurgical techniques to help patients keep their natural teeth and eliminate infection at its source.

Contact us today to schedule a consultation or to request a referral from your dentist.