What is an apicoectomy?
The apex is the very tip of a tooth root, where the nerve and blood vessels enter. Sometimes, even after a carefully performed root canal, infection remains around the apex. This can happen because of tiny side canals near the tip, a blocked or curved canal, or a root filling that cannot be removed safely.
In an apicoectomy, the dentist reaches the root tip through the gum and bone rather than through the crown of the tooth. The infected tissue around the apex is removed, the last few millimetres of the root are trimmed, and the end of the canal is sealed with a small biocompatible filling. The bone then heals around the sealed root over the following months.
When is root-end surgery recommended?
Apicoectomy is usually considered after other options have been reviewed. Typical situations include:
- A root-filled tooth with persistent infection where root canal retreatment has not resolved it
- A tooth with a well-made crown or a long post that would be at risk if removed
- A canal blocked by calcification or a separated instrument that cannot be negotiated
- A cyst or lesion at the root tip that needs removal and examination
Who may need an alternative?
Root-end surgery is not suitable for every tooth. If the root is cracked along its length, the tooth has lost much of its supporting bone, or the root is very short, an apicoectomy is unlikely to succeed. Teeth whose roots sit very close to the sinus or major nerves need particularly careful evaluation. In these cases we will discuss extraction and tooth replacement, such as a single tooth implant. For patients with heart conditions, diabetes or those taking blood thinners, we review your medical history and, where needed, coordinate with your physician before surgery.
The apicoectomy process at E&D Dental
- 3D planning. A low-dose 3D CBCT scan shows the size and position of the lesion, the root length, and nearby structures such as the sinus and nerve canal.
- Explaining the options. Dr. Ryu Si-ho or a member of our dental team explains why surgery is suggested, the alternatives, and whether it needs to be done now.
- Anesthesia and monitoring. The area is numbed using the clinic's 3-step painless anesthesia system: topical numbing, Endo-Frost cold numbing, then a computer-controlled injection. Vital-sign monitoring is available during the procedure for patients with chronic conditions.
- Access. A small flap of gum is lifted and a window is made in the bone over the root tip.
- Removal and sealing. Infected tissue is cleaned away, the root tip is trimmed, and the root end is prepared and filled with a sealing material.
- Closure. The gum is repositioned and stitched. Stitches are usually removed at a follow-up visit about a week later.
The procedure is performed under local anesthesia in a single appointment and instruments are sterilized to strict standards, including UV-C sterilization of handpieces.
Recovery and aftercare
Swelling and mild bruising are common for a few days and usually peak on the second or third day. To support healing:
- Apply a cold pack on the cheek in short intervals on the first day
- Eat soft, lukewarm food and chew on the other side
- Avoid smoking, alcohol and strenuous exercise for several days
- Brush gently around the area and use any prescribed rinse as directed
- Take medication exactly as instructed
Our TMJ physical therapy device, which supports tissue recovery and reduces pain and inflammation, may also be used after surgical procedures. Bone healing is checked with X-rays over the following months.
Risks and limitations
As with any oral surgery, there is a risk of infection, swelling, temporary numbness and slight gum recession at the surgical site. In the upper back teeth, the sinus may occasionally be involved. Not every apicoectomy heals as hoped, and if infection returns the tooth may eventually need to be extracted. We will discuss how likely surgery is to help in your specific case.
Why patients choose E&D Dental for root-end surgery
- CBCT-based planning around the sinus and nerve
- A natural-tooth-first philosophy with honest guidance when saving a tooth is not realistic
- Safety measures for elderly patients and those with chronic illness
- A convenient Sanbon location close to Line 4, with Saturday morning appointments
International residents can ask for help with English communication when booking. Contact our clinic to discuss whether an apicoectomy could help your tooth.