What is an apicoectomy?

A microsurgical procedure that removes infected tissue at the tip (apex) of a root and seals the end of the root to help the tooth heal when a prior root canal hasn’t fully resolved the infection.

When is apicoectomy recommended instead of retreatment?

When a tooth has persistent apical infection after root canal therapy and retreatment is unlikely to succeed or is not feasible due to posts, complex anatomy, or previous procedural complications.

How does success compare with nonsurgical retreatment?

Meta-analyses show surgery may have higher success at 2–4 years, while nonsurgical retreatment may surpass surgery at 4–6 years. Choice depends on tooth condition and prior treatment.

Possible risks include post-op discomfort, swelling, bleeding, sinus involvement for upper molars, or rare nerve irritation in lower molars. Careful planning reduces these risks.

How much does it cost vs. extraction and implant?

Apicoectomy is often less expensive than extraction plus implant. Exact fees vary with anatomy and complexity. We’ll review options, longevity, and total cost.

Apicoectomy and Retrograde Filling: Saving a Root Canal Tooth

Q: How successful is apicoectomy?

Modern microsurgical techniques with bioceramic/MTA root-end fillings report success rates around 90% at 2–5 years in systematic reviews.

Q: What materials are used to seal the root tip?

Mineral trioxide aggregate (MTA) and newer bioceramics are commonly used because they seal well and are biocompatible.

Q: What is recovery like?

Mild swelling or soreness for a few days is common. Most patients resume normal activities within 24–48 hours, following post-op instructions.

Q: Will I be numb during the procedure?

Yes. Local anesthesia is used; optional nitrous or oral sedation can improve comfort for anxious patients.

Q: How long does an apicoectomy take?

Typically 45–90 minutes per tooth, depending on location and complexity.

An apicoectomy with retrograde filling is a minor surgical procedure used to save a tooth when a previous root canal has failed. In many cases, a root canal can last for years, but sometimes the seal at the very tip of the root (apex) can break down. When that seal fails, bacteria can enter the space at the root tip and create an infection. The apicoectomy cleans things up at the end of root tip with a failing root canal and reseal it directly with retrograde filling.

Why does a root canal fail and what are the signs or syptoms?

Normally, our immune system manages small amounts of bacteria that constantly move through the body. But when a larger void develops around a failing root canal seal, bacteria can multiply and form a permanent “habitat.” This infection may go unnoticed for years—until it finally overwhelms the body’s defenses. At that point three things may occur from the failing root canal:

Abscess formation – swelling in the face or gum tissue, pain, fever, and an abscess visible on an X-ray.
sinus tract – the infection drains through a small open channel, leaving a constant pus drainage with little or no swelling or pain. Some patients notice a sulfur or metallic taste.
Pimple-like drainage cycle (gum boil)– a recurring pimple on the gum that fills with pus, pops, and drains repeatedly. Its basically a sinus tract that is closing filling as a pus cyst then discharging/ popping.

NOTE: If left untreated, bone loss around the root tip becomes more obvious on X-rays. The tooth can become loose.

This is what a sinus tract/gum boil looks like.

We determine the drainage route or sinus tract by sticking a gutta purch point to trace its origin. Here in this illustration it the 1st premolar right side .

What are the treatment Options when a root canal fails?

Root Canal Retreatment:

The preferred option if possible.The old root canal material is removed and resealed from the crown of the tooth downward. Sometimes impossible if there are posts or other obstructions in the tooth.

Restoration:

post and crown

Extraction:

Often the most predictable solution for molars and other hard-to-access teeth is extraction

Restoration:

dental implant
partial denture
fixed bridge
nothing and live with the space

Apicoectomy with retrograde filling:

This is done if retreatment is not an option due to limited access through the crown, post, or coronal restorations.

Restoration:

None the tooth remains the same

Which teeth are good candidates for apicoectomy and why?

Canines, lateral incisors, and central incisors are much easier to access making success more predictable.

GOOD CANDIDATES!

Molar/premolar are very hard to access which compromises success. They are expensive to treat. Extraction is often the best option.

NOT SO GOOD!

What are the reasons an apicoectomy would be prefered over retreatment?

In a retreatment an access hole is made in the top of crown or bridge which can distroy those restorations. Dental work such as cemented post can block access. To avoid that complication an apicoectomy is best.

How is an Apicoectomy Done?

Step 1 – Accessing the Root Tip
The gum tissue is gently lifted to expose the bone, and a small opening is made through the bone to reach the infected root tip.

Step 2 – Cleaning the Infection
Granulation tissue (infected or inflamed tissue) around the root is carefully removed.

Step 3 – Removing the Root Tip
The very end of the root is trimmed off, and a small preparation is made in the tip to hold a sealing material.

Step 4 – Sealing the Root End
The tip is sealed with a durable filling material, often MTA (a biocompatible cement) or sometimes amalgam, to prevent bacteria from re-entering.

Step 5 – Bone Graft
The cavity is filled with bone graft (synthetic hydroxyapatite), the gum tissue is repositioned and sutured, and healing begins. Patients typically take pain relievers, anti-inflammatories, and antibiotics for two weeks. with full bone healing expected over about 6 months.

Step 6 - Healing

Grafted bone remodels to natural bone. Full bone healing expected over about 6 months.

healing period 3-6 months after apicoectomy.

Apicoectomy: 7 Commonly Asked Questions

1. How successful is apicoectomy?

With modern microsurgical techniques and materials like MTA or bioceramics, success rates are about 90% ( NIH study ).

2. What materials are used to seal the root tip?

Mineral trioxide aggregate (MTA), amalgam, and newer bioceramics are highly biocompatible and seal the root tip effectively ( PubMed review ).

3. What is recovery like?

Most patients experience mild swelling or soreness for a few days. Normal activities usually resume in 24–48 hours with proper care.

4. Will I be numb during the procedure?

Yes. Local anesthesia ensures comfort. Nitrous oxide or oral sedation may be offered for anxious patients.

5. How long does an apicoectomy take?

Usually 1–2 hours per tooth, depending on tooth type, location, and complexity.

6. What are the risks?

Risks include swelling, bleeding, sinus involvement (upper molars), or nerve irritation (lower molars). Proper surgical technique reduces risks.

7. How much does it cost compared with extraction and implant?

Apicoectomy is often less expensive than extraction plus implant. Costs vary by tooth anatomy and complexity ($1000–$3000). During your consultation, all options will be reviewed.