Root canals have a success rate of around 95% — which means that for the vast majority of patients, a single procedure is all it takes to eliminate infection and save the tooth. But occasionally, a tooth that has already been treated continues to 
cause problems. Infection persists at the tip of the root, symptoms return, or a hidden issue that couldn’t be addressed through the crown of the tooth is preventing full healing.
When that happens, an apicoectomy may be the best path forward. It’s a minor surgical procedure — and for many patients, it’s what stands between keeping a natural tooth and losing it entirely.
Here’s a clear explanation of what an apicoectomy is, how it works, and when your endodontist might recommend one.
What Is an Apicoectomy?
An apicoectomy — also called root-end surgery — is a minor surgical procedure that targets the very tip of a tooth’s root (called the apex) rather than approaching the tooth from the crown down, as a conventional root canal does.
During the procedure, your endodontist makes a small incision in the gum tissue near the affected tooth to access the root tip and the surrounding bone. The last few millimeters of the root — along with any infected tissue — are removed. The root tip is then cleaned, shaped, and sealed with a small filling to prevent bacteria from re-entering.
Over the following weeks and months, the jawbone naturally heals around the treated area, and the tooth is preserved.
You can learn more about the procedure directly on our Apicoectomy page.
How Is It Different from a Root Canal?
A conventional root canal approaches the tooth from the top — through the crown — to clean, disinfect, and seal the canals from the inside out. This works well for the vast majority of cases.
An apicoectomy approaches from the bottom up, through a small opening in the gum and bone near the root tip. Rather than working through the full length of the canals, the procedure targets the very end of the root where infection may be lingering or where the canals are too complex to fully clean through conventional means.
The two procedures address the same problem — infection or inflammation at the root — but from different directions and for different circumstances.
When Is an Apicoectomy Necessary?
An apicoectomy is not a first-line treatment. It is typically considered after a conventional root canal — and in some cases a retreatment — has not fully resolved the problem. Your endodontist may recommend an apicoectomy in the following situations:
Persistent infection after root canal therapy
Sometimes, even after a thorough root canal, infection remains at the tip of the root. This can happen because the root canal system is more complex than imaging initially revealed, or because a small pocket of infection was beyond the reach of conventional instruments.
Root canal retreatment is not feasible
In some cases, reopening and retreating the tooth isn’t possible or advisable — for example, if a post or crown makes access impractical, or if prior treatment has already been attempted more than once. An apicoectomy offers an alternative surgical route to address the problem.
Hidden canals or missed anatomy
Teeth — particularly molars — can have root canal systems that are far more intricate than they appear on a standard X-ray. An apicoectomy, combined with 3D cone beam CT imaging, allows the endodontist to identify and address anatomy that was not visible or accessible during the original treatment.
Calcium deposits blocking the canals
Over time, calcification can narrow or completely block the interior of a root canal, making it impossible to clean through conventional methods. An apicoectomy allows the endodontist to address the problem at the root tip without needing to navigate through the blockage.
A cracked root tip that cannot be repaired
When a crack extends into the lower portion of the root but not the entire length, removing the cracked section via apicoectomy may allow the remainder of the tooth to be preserved. If the crack extends too far, extraction may be the only option — and your endodontist will be straightforward with you about which applies.
Bone loss near the root tip
In some cases, infection-related bone loss has occurred around the root tip. An apicoectomy clears the infected tissue, allowing the bone to regenerate and stabilize the tooth over time.
What to Expect During the Procedure
Apicoectomies are performed under local anesthetic, so the area is fully numb before anything begins. Most patients are surprised by how manageable the experience is — the procedure is shorter and less involved than many people expect.
Here’s a general overview of what happens:
- A small incision is made in the gum tissue near the affected root to expose the bone and root tip
- A tiny opening is created in the bone to allow access to the root tip and any surrounding infected tissue
- The last few millimeters of the root are removed along with any infected tissue
- The root tip is cleaned with ultrasonic instruments and sealed with a biocompatible filling material
- The gum is sutured closed and healing begins
The entire procedure typically takes 30 to 90 minutes depending on the location and complexity of the tooth. Most patients return to normal activity within a day or two, with some mild soreness at the incision site that resolves within a week or so.
Is It Painful?
During the procedure, the area is fully numbed with local anesthetic and most patients feel little to no discomfort. Afterward, some tenderness and mild swelling near the incision site is normal and typically manageable with over-the-counter pain relievers. If antibiotics are needed due to active infection, they will be prescribed.
For patients with significant dental anxiety, our team also offers IV sedation to make the experience as comfortable as possible from start to finish.
Learn more about our IV Sedation options.
What Is the Success Rate?
Apicoectomies have a strong track record. Studies consistently show success rates of 85–97% depending on the tooth, the extent of infection, and the technique used. Modern microsurgical approaches — using surgical microscopes, ultrasonic instruments, and advanced sealing materials — have significantly improved outcomes compared to older methods.
At Phoenix Endodontic Group, we use surgical microscopes and 3D cone beam CT imaging to ensure the most precise, thorough treatment possible. In many cases, an apicoectomy is what allows a tooth to be preserved when all other options have been exhausted.
What Happens If an Apicoectomy Isn’t Performed?
If persistent infection at the root tip is left untreated, the consequences can escalate:
- The infection can spread to surrounding bone and soft tissue
- A dental abscess may develop or worsen
- The tooth may ultimately require extraction
- Bone loss in the area can complicate future tooth replacement
For patients who want to keep their natural tooth and have already exhausted conventional treatment options, an apicoectomy is often the last viable alternative to extraction. It is worth pursuing.
For more on how root canal retreatment and apicoectomy work together as part of a comprehensive treatment plan, visit our Root Canal Retreatment page.
Why Choose Phoenix Endodontic Group for an Apicoectomy?
Endodontic microsurgery requires a high level of specialized training and precision. Not all dental providers perform apicoectomies, and not all use the advanced tools that make the procedure as effective as it can be.
At Phoenix Endodontic Group, Dr. Jacqueline S. Allen and Dr. James F. Wolcott bring decades of combined experience in complex endodontic care, including apicoectomies. Our team uses surgical microscopes for enhanced visibility, 3D cone beam CT imaging for accurate diagnosis and surgical planning, and the latest biocompatible sealing materials for optimal outcomes.
Learn more about our providers and their approach at phoenixendodontist.com/providers.
Still Have Questions About Apicoectomy?
If you’ve been told your tooth hasn’t fully healed after a root canal — or if you’re experiencing recurring symptoms in a previously treated tooth — we’d encourage you to schedule a consultation. There may be more options than you realize.
Call Phoenix Endodontic Group at (602) 242-4745 or contact us online to schedule your appointment. Same-day emergency appointments are available.