Apicoectomy: What to Expect Before, During, and After Treatment

When a tooth has undergone a root canal but the infection persists or returns, an apicoectomy is often the next recommended step. This minor oral surgery procedure is performed to remove the tip of a tooth’s root — the area where lingering infection is most likely to remain — and seal it with a biocompatible filling. For patients experiencing chronic inflammation or recurring discomfort after root canal therapy, an apicoectomy can be a highly successful treatment option that helps preserve the natural tooth and prevent further complications.

Understanding how the procedure works and what to expect can help ease anxiety and prepare you for a smooth healing experience.

Why an Apicoectomy May Be Needed

A root canal is designed to remove infected tissue inside the tooth’s canals. However, because of the complex anatomy of the root system, it is not always possible to remove every trace of infection—especially in cases involving:

• Curved or unusually shaped root canals

• Additional, hidden canals

• Narrow canals that are difficult to access

• Persistent inflammation in the surrounding bone

If these infected areas remain after a root canal, symptoms such as swelling, tenderness, or recurring infection may develop. When this occurs, a second root canal may be attempted first, as it is less invasive. However, if retreatment is unlikely to resolve the issue—or if previous treatment has failed more than once—an apicoectomy becomes the preferred and most effective solution.

How an Apicoectomy Works

An apicoectomy is a precise microsurgical procedure performed under local anesthesia, ensuring your comfort throughout the entire process.

1. Local Anesthetic

Before the procedure begins, a local anesthetic is administered to numb the area completely. You should not feel pain during the surgery, though light pressure or movement may be noticeable.

2. Accessing the Root Tip

The doctor will make a small incision in the gum tissue to gently expose the underlying bone and the root of the affected tooth. This gives direct access to the infected area.

3. Removing Infected Tissue

Using magnification and high-precision microsurgical instruments, the doctor carefully removes:

• Inflamed or infected tissue

• A small portion of the root tip (typically just a few millimeters)

This targeted approach allows the surgeon to eliminate infection without disturbing healthy tissue.

4. Placing a Root-End Filling

Once the root tip has been removed and the area thoroughly cleaned, the end of the root canal is sealed with a biocompatible filling material. This prevents reinfection and strengthens the tooth’s foundation.

5. Suturing the Gum Tissue

The gum is then repositioned and sutured (stitched) closed. Depending on the type of sutures used, you may either return in a few days for removal or they may dissolve on their own.

Recovery and Healing After an Apicoectomy

Following the procedure, you may experience mild swelling or discomfort — both normal parts of the healing process. Most patients find these symptoms manageable with over-the-counter pain medication or any prescribed medication provided by the doctor.

What to Expect After Surgery

• Mild swelling for 48–72 hours

• Tenderness or slight soreness at the surgical site

• Bruising in some cases

• Gradual improvement over the first week

Most people are able to resume everyday activities within 24 hours, although strenuous exercise should be avoided for the first couple of days.

Long-Term Healing

Over the next few months, the surrounding bone will naturally begin to regenerate and heal around the treated root. This process strengthens the tooth and helps restore full stability.

The high precision of the surgery gives apicoectomies an excellent success rate, especially when performed by an experienced dental professional.

When to Call the Office

Contact your dental team if you experience:

• Persistent or worsening pain

• Excessive swelling after several days

• Bleeding that does not stop

• Signs of infection (fever, foul taste, pus)

Prompt attention ensures the best possible healing outcome.

Preserving Your Natural Tooth

An apicoectomy is often the final step available to save a tooth that continues to have issues after root canal therapy. By removing the source of lingering infection and sealing the root end, this procedure helps prevent extraction and maintains the natural tooth structure whenever possible.

If you are experiencing symptoms after a previous root canal or have been advised to consider an apicoectomy, our team is here to answer your questions and guide you through the next steps with clarity and care.