What an apicoectomy is
An apicoectomy is a small surgical procedure used to save a tooth that still has inflammation at its root tip. Instead of working from above through the crown of the tooth, as in a root canal, we approach the root tip from the outside through the gum. There we remove the inflamed bone and the lower end of the root, then seal the root canal tightly from below.
At its core the procedure has two steps. First, the removal of the inflamed root tip, which is where the name comes from. Second, the retrograde seal, a small filling placed from below that closes the canal so that bacteria can no longer pass from inside the root into the bone. For this filling we use a biocompatible material such as MTA, which is well tolerated by the surrounding tissue and seals the canal reliably.
When an apicoectomy is needed
A root canal is very successful, but it does not heal completely in every case. When inflammation at the root tip persists or returns, the apicoectomy comes into play. Typical reasons are:
- Persistent inflammation at the root tip despite a properly performed root canal, often as a chronic focus visible on the X-ray.
- A repeat root canal through the tooth is not possible or has already failed. Sometimes the canal cannot be cleaned out cleanly again from above.
- Anatomical obstacles such as strongly curved canals, broken instruments or calcified sections that block access from above.
- A post or crown that should not be removed, because removing it would weaken the tooth or destroy an expensive, well-fitting restoration.
In these situations the route from the outside is often gentler on the tooth than drilling through it again from above. Whether the procedure is indicated for you is something we always clarify on the basis of the findings and an X-ray or 3D image, never as a matter of routine.
How it differs from the other routes
For an inflamed tooth there are three basic routes. We follow a clear order of priority: keep the tooth as long as that is reasonable.
- Root canal revision. The first attempt is usually to redo the existing root canal through the crown of the tooth. You can read more about this in our article on root canal treatment. When that route is blocked or has already failed, the apicoectomy follows.
- Apicoectomy. The surgical access from the outside, when treatment from above does not achieve the goal. The tooth is kept.
- Extraction plus replacement. Only when the tooth is no longer worth preserving, for example with a lengthwise fracture of the root, is it extracted and replaced with an implant or a bridge. How this trade-off works is described in our comparison of root canal vs extraction.
The apicoectomy therefore sits precisely between keeping the tooth from above and extracting it. It is the attempt to save your own tooth before a replacement is considered.
The procedure step by step
The sequence is well established and usually completed in a single session:
- Local anaesthesia. The area around the tooth is numbed so that you feel no pain during the procedure.
- Small flap. We carefully lift the gum over the root tip as a small flap and expose the bone beneath it.
- Access to the root tip. Through a small opening in the bone we reach the inflamed root tip and the surrounding tissue.
- Removal. The tip of the root and the inflamed tissue are removed. Under the operating microscope the canal can be assessed precisely.
- Retrograde filling. The canal is sealed tightly from below with a biocompatible material such as MTA, so that no more bacteria can escape.
- Sutures. The flap is laid back and fixed with fine sutures. These are removed after about seven days.
The use of magnification and fine instruments is the reason this is now called microsurgical apicoectomy. As a procedure in oral surgery, it belongs in experienced hands. On request, or in cases of marked anxiety, we carry out the procedure under sedation or general anaesthesia through our own anaesthesia department.
Success rates
Success rates have risen markedly with the modern technique. In the past the work was done without magnification and with coarser filling materials. Today the operating microscope and a biocompatible retrograde seal allow far more precise work. Current studies report healing rates in the region of around nine out of ten cases. The specific outcome depends on the tooth, the cause of the inflammation and your general oral health. We discuss the outlook for your case openly with you before the procedure.
Recovery and aftercare
In the first few days some swelling and mild wound soreness are normal. The swelling usually peaks after two to three days and is well controlled by cooling. Take it easy on the area, chew on the other side and keep the area gently clean when brushing. We remove the sutures after about seven days. Most people feel largely back to normal after roughly a week. The bone heals at the root tip over several months and is checked at a follow-up with an X-ray.
Risks
The apicoectomy is an established, well-planned procedure. As with any operation there are risks, which are addressed in the preliminary consultation. These include temporary swelling or bruising, and in rare cases secondary bleeding or an infection of the wound. Depending on the position of the tooth, proximity to neighbouring structures such as a nerve or the maxillary sinus can play a role. This is precisely why we plan the procedure on the basis of an X-ray or 3D image and clarify the anatomy beforehand.
When to come to us
If a root-treated tooth keeps causing trouble, hurts under pressure, shows a swelling at the gum or reveals inflammation at the root tip on the X-ray, an assessment is worthwhile. Often the tooth can be saved with an apicoectomy. Book an appointment and we will assess the findings and discuss the right route with you. Costs follow the SSO tariff. Before the procedure you receive a written cost estimate from us, so that you know what to expect.