What Is an Apicoectomy?
An apicoectomy is a microsurgical procedure that removes the infected tip of a tooth root and the surrounding tissue, then seals the end of the root while leaving the crown and remaining root intact. The procedure provides direct surgical access to the root end, allowing the endodontist to treat persistent infection at its source.
This microsurgical approach can help preserve a natural tooth when infection persists at the root tip despite previous treatment. Our patient’s guide to apicoectomy explains the procedure from the patient’s perspective.
When Is an Apicoectomy Necessary?
An apicoectomy may be necessary when a tooth that has already had root canal treatment still shows signs of infection or inflammation near the root tip. Symptoms can include tenderness when biting, a persistent ache near the gumline or an area on an X-ray that has not healed as expected after treatment.
Persistent inflammation around the root tip, sometimes called apical periodontitis, is one possible reason for an apicoectomy procedure. The endodontist reviews your symptoms, previous treatment and diagnostic imaging to determine the source of the problem and whether surgery is appropriate.
In some cases, calcium deposits can narrow the canal to the point where instruments used during non-surgical retreatment cannot reach the root end. Surgery provides direct access to clean and seal the affected area.
The tooth must also have enough healthy structure to remain functional after treatment. A vertical root fracture, extensive structural damage or a poor long-term restorative outlook may make apicoectomy surgery less appropriate. Depending on the cause of the problem and the condition of the tooth, nonsurgical retreatment or tooth extraction may sometimes provide a better treatment option.
| Approach | Best suited for | Access point |
|---|---|---|
| Retreatment | Infection that can be addressed through the existing root canal system | Through the crown |
| Apicoectomy | Persistent infection near the root tip when retreatment is not practical or has not resolved the problem | Through the gum, at the root apex |
| Extraction | Severe root fracture or insufficient tooth structure for long-term function | Removal of the tooth |
Patients weighing retreatment against surgery often ask about durability, and our article on how long a retreated root canal lasts addresses that question directly.
How Does an Apicoectomy Procedure Work?
An apicoectomy procedure follows a carefully planned sequence designed to remove infection, seal the root end and preserve healthy root structure. The endodontist may use 3D imaging and a surgical microscope to evaluate the root and surrounding bone before and during treatment.
Apicoectomy FAQs
How long does an apicoectomy take?
Most apicoectomies are completed in a single visit lasting roughly 60 to 90 minutes, depending on which tooth is involved and how much bone sits over the root tip. Front teeth generally require less chair time than molars, where the roots run deeper and closer to other structures. Our specialists confirm the expected length at the planning visit, once the imaging shows what the surgery needs to address.
Will I need a new crown after an apicoectomy?
No. The crown of the tooth stays untouched during the procedure, since the surgery reaches the root tip through the gum rather than through the biting surface. An existing crown or filling only needs replacing if it was already failing or if decay turns up underneath it during the exam.
How much does an apicoectomy cost?
Cost varies by tooth, by the complexity of the root anatomy and by whether 3D imaging or sedation is part of the treatment plan. Molars generally cost more than front teeth because the roots are more difficult to access. Our team provides a written estimate after the consultation, once the imaging shows exactly what the procedure involves.
Does insurance cover an apicoectomy?
Yes, most dental plans include some level of coverage for endodontic surgery, though the percentage and the annual maximum vary by policy. Our team verifies your benefits before treatment and provides an estimate of what the plan is expected to pay, and our insurance and financial information page outlines the plans we accept. Payment options are available for any remaining balance.
Can an apicoectomy be performed twice on the same tooth?
Yes, a second apicoectomy is possible in select cases, though success becomes less predictable once a first surgery has failed to resolve the infection. The decision rests on how much healthy root and bone remain and on what repeat imaging reveals about the cause of the failure. Extraction with a tooth replacement plan often becomes the more reliable option at that stage.
What should I eat after apicoectomy?
Stick to soft, cool foods for the first two or three days and chew on the opposite side of the mouth to keep pressure off the surgical site. Yogurt, eggs, soft pasta, and smoothies eaten with a spoon rather than a straw work well during that window. Return to a normal diet once chewing on the treated side feels comfortable again, usually within about a week.
