Apicoectomy: The Root-Tip Surgery That Saves a Tooth

Editorially reviewed by the Dental.me Editorial Team · Updated July 2026

When a tooth still aches or shows signs of infection long after a root canal, it can feel like the only option left is to pull it. But there is often one more step that can preserve your natural tooth: an apicoectomy. Also called a root-end resection or root-tip surgery, an apicoectomy is a minor oral surgery that removes the very tip of a tooth’s root along with the infected tissue around it, then seals the end to stop the problem from coming back. It sounds intimidating, but it is a routine, well-established procedure with a strong track record for saving teeth. Here is what it involves, when it is needed, and what recovery really looks like.

What Is an Apicoectomy?

An apicoectomy is a surgical procedure that treats a persistent infection or inflammation at the very bottom of a tooth’s root, an area called the apex. During the procedure, a dentist or specialist makes a small opening in the gum to reach the root tip, removes the tip along with any diseased tissue, cleans the area, and places a tiny filling to seal the end of the root canal from the bottom. The gum is then closed with stitches so it can heal.

The word itself explains the surgery: “apico” refers to the apex, or tip, of the root, and “ectomy” means removal. So an apicoectomy is quite literally the removal of the root tip. It is considered a form of endodontic microsurgery, and it is often described as one of the last steps available to save a tooth before extraction becomes necessary.

When Is an Apicoectomy Needed?

Most of the time, an apicoectomy is recommended when a previous root canal has not fully healed and infection or inflammation lingers at the root tip. A standard root canal cleans out the inside of the tooth from the top, but the root system can be complex, with tiny branching canals that are difficult to fully clean or seal. If bacteria remain, an abscess or ongoing infection can develop at the apex.

Before turning to surgery, the first choice is usually a nonsurgical root canal retreatment, where the original filling is removed and the canals are cleaned and sealed again from the top. An apicoectomy is typically considered when retreatment is not possible or has already failed, for example when a post, crown, or complex restoration would be damaged by reopening the tooth from above. In those cases, accessing the problem from the root tip is the more practical path.

Signs that might lead your dentist to recommend this surgery include a tooth that stays tender to pressure, gum swelling or a small bump near the root, or an infection that keeps returning on X-rays despite prior treatment. The goal in every case is the same: clear the infection and keep your natural tooth in place.

Who Performs It and How It Differs From a Root Canal

An apicoectomy is usually performed by an endodontist, a dental specialist who focuses on the inside of the tooth and the tissue around the root, or by an oral surgeon. Endodontists often use a surgical microscope and specialized instruments, which makes this a precise, minimally invasive procedure.

People sometimes confuse an apicoectomy with a root canal, but they approach the tooth from opposite directions:

• A root canal works from the crown, or top, of the tooth downward. The dentist drills through the biting surface, cleans out the canals, and fills them from the inside.
• An apicoectomy works from the side, through the gum, to reach the root tip. Only the very end of the root and the surrounding infected tissue are removed, and a small filling seals the root from the bottom.

In short, a root canal treats the tooth from the top down, while an apicoectomy treats it from the tip up, targeting the specific area that a root canal could not fully resolve.

What Happens During the Procedure

An apicoectomy is typically done in a single visit and usually takes less than an hour, though the exact time depends on which tooth is involved and how complex the roots are. Here is a general overview of what to expect:

• Numbing: The area is numbed with a local anesthetic, so you should not feel pain during the surgery, only pressure or movement.
• Small incision: The specialist makes a small cut in the gum near the affected tooth and gently lifts the gum tissue to expose the underlying bone and root tip.
• Removing the tip: The infected root tip and any surrounding diseased tissue are removed, and the area is thoroughly cleaned.
• Sealing the root: A tiny filling is placed at the end of the root canal to seal it and prevent bacteria from re-entering.
• Stitching: The gum is repositioned and closed with a few stitches, which may dissolve on their own or be removed at a follow-up visit.

Over the following months, the bone around the root tip gradually heals and fills in, which is why your dentist may want a follow-up X-ray down the line to confirm everything has resolved.

Is It Painful, and What Is Recovery Like?

You should be comfortable during the surgery itself because of the local anesthetic. Afterward, it is normal to have some soreness, swelling, and occasionally minor bruising for a few days as the area heals. For most people this discomfort is mild to moderate and manageable with over-the-counter pain relievers and ice.

To support a smooth recovery, your dentist will usually recommend a few simple steps:

• Apply ice to the outside of your face during the first day to limit swelling.
• Stick to soft foods and chew on the opposite side while the area heals.
• Avoid brushing directly on the surgical site at first, and use gentle salt-water rinses as advised.
• Use any prescribed rinse, pain relief, or antibiotics exactly as directed.
• Do not smoke, and avoid vigorous exercise for a short period, since both can slow healing.

Most of the swelling and discomfort ease within a few days, and any non-dissolving stitches are typically removed about a week after surgery. The gum surface heals quickly, while the bone underneath continues to fill in over the following months.

Success Rates, Risks, and Alternatives

Apicoectomy success rates are generally high, and for many people the procedure resolves a stubborn infection and lets them keep a tooth that would otherwise be lost. Like any surgery, it carries some risks, though they are usually minor. These can include infection at the site, temporary numbness or tingling if the root is near a nerve, and the possibility that the procedure may not fully resolve the problem, in which case extraction could still be needed.

If a tooth cannot be saved, the alternative is to remove it and replace it with a dental implant or bridge. While those replacements work well, dentists generally prefer to preserve the natural tooth whenever it is reasonable to do so. A natural tooth maintains the bone and bite in ways a replacement cannot fully match, and keeping it often means avoiding more extensive and costly work later, such as a crown on an implant. That is a big part of why an apicoectomy is worth considering before giving up on a tooth.

As for cost, it varies depending on the tooth, your location, and your provider, and dental insurance may cover part of it, especially since it is a treatment aimed at saving a tooth. It is worth asking your dentist’s office for an estimate and checking your coverage before the procedure.

The Takeaway

An apicoectomy removes the infected tip of a tooth’s root to clear a lingering infection that a root canal alone did not resolve. It is a quick, minor surgery, usually performed by an endodontist, with a manageable few-day recovery and a strong success rate at preserving your natural tooth. If you have a tooth that keeps hurting or shows signs of infection after root canal treatment, do not assume extraction is the only answer. See your dentist or an endodontist promptly, because a small procedure at the root tip may be all it takes to save your smile.

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