by Dr. Jacqueline S. Allen | Aug 11, 2026 | Apicoectomy, Blog, Root Canal
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.
by Dr. Jacqueline S. Allen | Jan 15, 2026 | Apicoectomy, Blog, Root Canal
At Phoenix Endodontic Group, we specialize in advanced endodontic care designed to diagnose, treat, and preserve your natural teeth whenever possible. With decades of combined experience serving patients throughout the Valley, our team combines compassionate care with cutting-edge technology to deliver excellent outcomes. Whether you have been referred by your dentist or are experiencing tooth pain or injury, we offer a comprehensive range of services focused on comfort, precision, and long-term oral health.
Root Canal Therapy – Saving Natural Teeth
Root canal therapy is the most common service provided at Phoenix Endodontic Group and one of the most effective ways to relieve tooth pain and prevent extraction. This treatment removes infected or inflamed tissue from inside the tooth, thoroughly cleans the root canal system, and seals it to prevent reinfection. Our endodontists perform root canal procedures using advanced techniques and technology to improve accuracy, reduce discomfort, and support faster healing while preserving as much natural tooth structure as possible.
Root Canal Retreatment
In some cases, a tooth that has previously undergone root canal therapy may develop new symptoms or fail to heal completely. Root canal retreatment allows our specialists to reopen the tooth, remove the original filling material, address lingering infection, and reseal the canals. Using advanced diagnostic tools, including 3D imaging when necessary, we can identify hidden canals, fractures, or other issues that may have contributed to treatment failure. Retreatment often provides a second opportunity to save a natural tooth.
Apicoectomy
When infection persists at the tip of the root despite root canal therapy, an apicoectomy may be recommended. This minor surgical procedure involves removing the infected tissue and the very end of the root, then sealing the root tip to prevent further infection. Apicoectomies are typically performed when conventional treatment alone is not sufficient and are often successful in preserving teeth that might otherwise require extraction.
Emergency Endodontic Care
Dental emergencies can occur suddenly and often involve significant pain or swelling. Phoenix Endodontic Group offers same-day emergency care for patients experiencing severe tooth pain, infection, or dental trauma. Prompt treatment is critical in emergency situations, as early intervention can prevent complications and increase the likelihood of saving the affected tooth. Our team evaluates each case quickly and develops an appropriate treatment plan to address the issue efficiently.
Treatment for Cracked, Broken, or Traumatized Teeth
Dental injuries such as cracked, chipped, or displaced teeth often require specialized endodontic care. Trauma can damage the inner pulp of a tooth even if the outer structure appears intact. Our specialists are trained to diagnose and treat traumatic dental injuries, including teeth that have been knocked out or fractured. Timely treatment can stabilize the tooth, relieve pain, and significantly improve long-term outcomes.
Advanced Technology and the GentleWave Procedure
Phoenix Endodontic Group uses modern technology to enhance precision and patient comfort. This includes surgical microscopes, advanced irrigation techniques, and the GentleWave procedure, which allows for more thorough cleaning of complex root canal systems. We also utilize 3D cone-beam imaging when needed to visualize anatomy that traditional X-rays may miss. These technologies help improve treatment success and reduce the likelihood of future complications.
IV Sedation for Patient Comfort
For patients with dental anxiety, strong gag reflexes, or complex treatment needs, IV sedation is available. IV sedation helps patients remain deeply relaxed and comfortable throughout their procedure and is monitored by a licensed anesthesiologist. This option allows patients to receive necessary care with minimal stress and discomfort.
Dental Implants When Tooth Preservation Is Not Possible
Although preserving natural teeth is always our priority, some teeth cannot be saved due to severe damage or infection. In these cases, Phoenix Endodontic Group offers dental implant services as a long-term tooth replacement solution. Dental implants restore function, appearance, and stability while supporting overall oral health.
Comprehensive, Patient-Focused Care
Across all services, Phoenix Endodontic Group is committed to providing high-quality, patient-centered care. We take time to explain treatment options, answer questions, and ensure each patient feels informed and comfortable. Our goal is to deliver exceptional outcomes while making every visit as stress-free as possible.
Trusted Endodontic Care in the Phoenix Area
Phoenix Endodontic Group has earned a reputation for excellence by focusing on advanced care, compassionate service, and proven results. Whether you need routine root canal therapy, emergency treatment, or specialized surgical care, our comprehensive services are designed to protect your oral health and preserve your smile.
If you are experiencing tooth pain or have been referred for specialized care, Phoenix Endodontic Group is here to help.
by Dr. Jacqueline S. Allen | Oct 3, 2016 | Apicoectomy, Blog, Root Canal
Even though contemporary root canal procedures have very high success rates, not every root canal treatment is permanently effective. Tooth root systems can be complex, and undiscovered and untreated canals can harbor infections that threaten the pulp of a tooth months, or even years, after the initial procedure.
If you’re experiencing pain and swelling around a tooth that’s received a root canal, visit your dentist or endodontist to have it examined. He or she may suggest that an endodontist perform an apicoectomy, which treats an infected tooth from its root end, rather than from the biting surface of the tooth.
Here’s a brief guide to how an apicoectomy can save a natural tooth that’s already received a root canal treatment.
Apicoectomy: A Step Beyond Root Canal Treatment
- Apicoectomies can be useful when a root canal retreatment won’t work. If the tooth has received a crown as part of its root canal process, or is part of a fixed dental bridge, those restorations will have to be disassembled and replaced to do another root canal. Accessing the infection through the root avoids this.
- An apicoectomy removes and seals the tip of the tooth root. During an apicoectomy, the endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed, along with the last few millimeters of the root tip. Then the endodontist cleans and seals the end of that root, removing a critical avenue where infection can manifest and cause problems.
- The preparation for an apicoectomy gives the endodontist an accurate picture of your natural tooth. Endodontists use state-of-the-art technology to perform apicoectomies, including fiber optic lights, operating microscopes and ultrasonic cleaning instruments that remove infection via high frequency vibration. Between this and the imaging technologies employed before the procedure, your endodontist will have an exceptionally clear picture of the health of your tooth, and what can be done to preserve it.
“If an infection threatens a tooth that’s had a root canal, and a retreatment isn’t an option, an apicoectomy can preserve it and keep it useful and functional for years to come,” says Dr. Allen of the Phoenix Endodontic Group.
by Dr. Jacqueline S. Allen | Jul 17, 2015 | Apicoectomy, Blog, Endodontics, Phoenix Endodontic Group
Root canal treatments have a high success rate when it comes to saving an infected tooth – close to 95 percent. However, sometimes a standard root canal will fail and a surgical procedure known as an apicoectomy will be necessary.
Why Root Canals Can Fail
Dr. Jaqueline S. Allen, an endodontist with the Phoenix Endodontic Group, explained that there are a number of reasons that a root canal treatment might not be successful.
“Sometimes there is simply not enough tooth left to place a functional restoration,” Dr. Allen explained. “Other reasons for root canal failures can include a vertical fracture in the root that cannot withstand chewing on the tooth, a poor crown to root ratio, or an unusual root anatomy that creates difficulty in cleaning the entire root structure.”
Two other reasons that a root canal treatment might not succeed include a significant delay in the final crown being placed on top of the treated tooth, and when a successfully treated tooth develops an infection later, perhaps due to new cracks or fractures in the tooth, or additional tooth decay.
How an Apicoectomy Differs From a Root Canal
There are several significant differences between a standard root canal treatment and an apicoectomy:
- In a root canal, the endodontist approaches the treatment by going through the crown of the tooth. In an apicoectomy, he or she will perform the treatment by starting at the root (or apex) end of the tooth. To do this, he or she must make an incision and move the gums out of the way.
- During a standard root canal, the focus is on cleaning all the root canals in the tooth. For an apicoectomy, since the other canals have already been filled and sealed, the focus is on removing the infected tooth root and placing a small filling to prevent further problems.
- Because an apicoectomy requires a gum incision, stitches will be necessary, and bone grafts may be used to encourage your jawbone to fill in the area around the tooth root that is removed.
As far as recovery from an apicoectomy is concerned, Dr. Allen advised that patients should be prepared for possible post-operative bruising or/and swelling (which can be taken care of with the application of ice packs), and should allow one to two hours for the procedure itself. They should avoid vigorous exercise for several days and should avoid brushing in the area for two to five days. A return appointment to remove the sutures will also be necessary.
by Dr. Jacqueline S. Allen | Jun 2, 2015 | Apicoectomy, Blog, Endodontics
Although modern dentistry offers amazing artificial tooth restoration options, nothing is as good as a functional natural tooth. Your endodontist may recommend you have a surgical procedure known as an apicoectomy to save your natural tooth if you’ve had a root canal treatment that hasn’t been entirely successful.
Since an apicoectomy differs from a standard root canal treatment, it helps to know what to expect. Here are a few quick facts about the surgery and its impact on your oral health.
Having an Apicoectomy: What You Need To Know
- What it is: An apicoectomy is surgery on the end of your tooth root (also known as the apex). The infected tooth root is removed and a small filling placed to prevent further problems. Dr. Allen of the Phoenix Endodontic Group explains that during an apicoectomy, “Your endodontist will make an incision on your gum tissue to move it out of the way temporarily. Then they will perform microsurgery on the end of the roots and put the gum tissue back into place.”
- Why it is needed: You may need an apicoectomy because the tooth that received a root canal treatment has complex roots. The surgery may also need to be performed because the tooth in question has a crown or a bridge and retreatment of the root would require the cutting through the restoration.
- Preparation for the procedure: Before your apicoectomy, your endodontist will take X-rays of the tooth and surrounding bone. You may be given an antimicrobial mouth rinse, a medicine to reduce inflammation, and/or antibiotics to get your mouth in the best possible condition for the surgery.
- Post-apicoectomy recovery: For the first 12 hours, you’ll want to apply ice packs to the side of the face near the affected area – 20 minutes on, 20 minutes off. Avoid eating crunchy or hard foods for the first few days. Dr. Allen advises, “There is minimal discomfort after apical surgery, but there can be some swelling. That can be minimized with ice packs.” You should recover from the procedure within two weeks. Eventually, the bone heals around the end of the root.
Dr. Allen concludes, “Apicoectomies give patients with tooth root infections another chance to save their tooth. It is the most biologic and cost-effective option for maintaining your oral health.”
