An apicoectomy — also referred to as root-end resection or periradicular surgery — is a minor surgical procedure in which the tip of a tooth’s root (the apex) and any associated infected tissue are removed to eliminate persistent periapical pathology that has not responded to conventional endodontic treatment.

When an Apicoectomy Is Indicated

An apicoectomy is considered when standard root canal therapy or orthograde retreatment has failed, or when retreatment is not clinically feasible. Common indications include:

• A persistent periapical abscess or cyst that does not resolve following conventional root canal treatment
• Calcified or blocked canals that prevent adequate instrument access from the crown
• Fractured endodontic instruments lodged near the root apex that cannot be retrieved
• Existing crowns or post-and-core restorations that make orthograde retreatment impractical
• Procedural complications such as root perforation or significant ledging near the apex

How the Procedure Works

The procedure is performed under local anesthesia. A small incision is made in the gingival tissue adjacent to the affected tooth, and a soft-tissue flap is reflected to expose the underlying alveolar bone. A small window is created in the bone to access the root apex directly.

The infected periapical tissue — commonly a periapical granuloma or cyst — is curetted away, and approximately three millimeters of the root tip are resected using a surgical bur. The root-end cavity is then prepared with ultrasonic instruments and sealed with a retrograde filling material, most commonly mineral trioxide aggregate (MTA), to prevent bacterial microleakage. The flap is repositioned and sutured closed.

Healing and Prognosis

Bone fill and periapical healing are evaluated radiographically over a six- to twelve-month period. Success rates for apicoectomy performed with proper magnification and ultrasonic root-end preparation frequently exceed 85 percent in well-selected cases. The size of the periapical lesion, the integrity of the coronal restoration, and the health of the surrounding periodontal ligament all influence long-term outcomes.

When performed with careful case selection, adequate magnification, and biocompatible materials, an apicoectomy offers a reliable path to preserving a tooth that would otherwise require extraction.