Most teeth treated with a root canal heal and last. Occasionally a tooth stays inflamed or becomes infected again, or has a problem that nonsurgical treatment can’t reach. In those cases, an endodontist may recommend surgery to save the tooth. The most common procedure is an apicoectomy, also called root-end resection. This guide draws on the American Association of Endodontists (AAE).
Why endodontic surgery may be needed
The AAE describes several situations:
- Diagnosis: if you have persistent symptoms but nothing shows on X-rays, there may be a tiny fracture or a canal missed during nonsurgical treatment. Surgery lets the endodontist examine the whole root.
- Calcified canals: calcium deposits can make a canal too narrow for root canal instruments to reach the end of the root.
- Failure to heal: a tooth may not heal, or may become painful or infected months or even years after successful treatment.
- Damaged root surfaces or surrounding bone.
The AAE says an apicoectomy may be needed when inflammation or infection persists in the bone around the end of the tooth after a root canal. For background, see our root canal guide and tooth abscess signs.
What happens during an apicoectomy
- The endodontist applies local anesthesia.
- The gum tissue near the tooth is opened to see the bone underneath.
- Inflamed or infected tissue is removed, along with the very end of the root.
- A small filling may be placed to seal the end of the root canal.
- A few stitches help the gum tissue heal.
The AAE says digital imaging and operating microscopes help these procedures go quickly, comfortably and successfully. Over the following months, the bone heals around the end of the root.
Other types of endodontic surgery
The AAE lists dividing a tooth in half, repairing an injured root, and removing one or more roots. In intentional replantation, a tooth is extracted, treated outside the mouth and put back in its socket.
Recovery: what to expect
- Comfort: local anesthetics make the procedure comfortable. Some discomfort or slight swelling while the incision heals is normal, and the AAE says post-surgical discomfort is generally mild.
- Pain relief: your endodontist will recommend medication and give specific aftercare instructions.
- Driving: often you can drive yourself home, but ask beforehand so you can arrange a ride if needed.
- Back to normal: most patients return to work or routine activities the next day.
Call your endodontist if you have questions or pain that doesn’t respond to medication.
Success and alternatives
The AAE notes there are no guarantees with any surgery, and your endodontist will discuss your chances so you can decide. Often the only alternative is extraction. The tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing and keep neighboring teeth from shifting. The AAE says endodontic surgery is usually the most biologic and cost-effective way to keep your natural tooth. Compare options in implants vs bridges vs dentures and tooth extraction recovery.
Cost and insurance
The AAE says each insurance plan is different, so check with your employer or insurer before treatment. Ask for a written estimate. See how to read a dental treatment plan.
Questions to ask your endodontist
- Why is surgery recommended over retreatment or extraction?
- What are my chances of success?
- What should I expect for pain, swelling and time off?
Frequently asked questions
Does an apicoectomy hurt?
The AAE says local anesthetics make it comfortable, and post-surgical discomfort is generally mild.
Who performs it?
An endodontist, a specialist in the tooth’s pulp and roots. See dental specialists explained.
Sources
- American Association of Endodontists: Endodontic Surgery Explained
- American Association of Endodontists: Endodontic Surgery
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “SYNCA CJ-Optik Flexion Twin microscope and A-dec 500 LED lights” by Kiran891, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.
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