[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Endodontics](https://durgical.com/en/dentistry/areas/endodontics/) › Endodontic surgery: apicoectomy # Endodontic surgery: apicoectomy - Procedure When a root canal cannot be redone through the crown, the infected root tip can be removed through the gum and bone and the root end sealed. Updated Nov 12, 2026 **See it in 3D:** [Mental foramen](https://durgical.com/en/anatomy/mental-foramen/) · [Maxillary sinus](https://durgical.com/en/anatomy/maxillary-sinus/) · [Inferior alveolar nerve](https://durgical.com/en/anatomy/inferior-alveolar-nerve/) ## Key points - Flap, bone window, root-end resection, ultrasonic preparation, calcium silicate filling. - Watch the mental foramen and the sinus. - Send the tissue for histology. ## What it is Apical surgery (apicoectomy) treats persistent apical periodontitis from outside the tooth. Through a gum flap, a small window is made in the bone, the root tip with its complex apical branches is cut off, and the end of the canal is cleaned with ultrasonic tips and sealed with a root-end filling. With a microscope and calcium silicate root-end fillings, success is much higher than with older techniques. ## Indications and contraindications - Indications: failed root canal treatment when retreatment is not possible or has failed, a post or crown that cannot be removed, and the need for a biopsy. - Contraindications: a tooth that cannot be restored, poor periodontal support, a vertical root fracture, uncontrolled medical conditions. - Anatomy to protect: the mental foramen and inferior alveolar canal near lower premolars and molars, and the maxillary sinus near upper molars. - About the last few millimetres of root are removed, where most apical branches lie. - The tissue removed is sent for histology. ## How it is done - Assess with radiographs (often CBCT), the medical history and antithrombotic medicines. - Give local anaesthesia and raise a full-thickness flap. - Remove bone to expose the root tip and curette the lesion. - Resect the root end and inspect it under magnification for missed canals and cracks. - Prepare the canal end with ultrasonic tips and fill it with a calcium silicate cement. - Close the flap with sutures; review healing clinically and with radiographs. ## Complications and pitfalls - Complications: swelling and bruising, nerve injury with numbness of the lip, sinus perforation, and gum recession at the flap. - A crack found at the resected root end usually means extraction instead. - Patients on anticoagulants can usually continue them with local haemostatic measures, as for an extraction. ## Next step / Initial management - Failed root canal not suited to retreatment: refer to the endodontist or oral surgeon for apical surgery. - Send all excised periapical tissue for histology. - Numbness of the lip after lower posterior apical surgery: refer back the same day. ## Test yourself Think of the answer, then tap the question to see it. ## What is the main indication for apical surgery? Persistent apical periodontitis after root canal treatment when non-surgical retreatment is not possible or has failed. ## Which material is preferred for the root-end filling? A calcium silicate cement such as mineral trioxide aggregate. ## Which structures are at risk in apical surgery on lower premolars? The mental nerve at the mental foramen and the inferior alveolar nerve. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/endodontic-surgery-apicoectomy/) ## Connections ## See it in 3D 3 The structures of Durgical's 3D anatomy where it is found. - [Mental foramen](https://durgical.com/en/anatomy/mental-foramen/) - [Maxillary sinus](https://durgical.com/en/anatomy/maxillary-sinus/) - [Inferior alveolar nerve](https://durgical.com/en/anatomy/inferior-alveolar-nerve/) ## Related 4 - [When a root canal fails: retreatment](https://durgical.com/en/dentistry/when-a-root-canal-fails-retreatment/) - [Root canal filling materials and sealers](https://durgical.com/en/dentistry/root-canal-filling-materials-and-sealers/) - [Maxilla and mandible: applied anatomy for dentistry](https://durgical.com/en/dentistry/maxilla-and-mandible-applied-anatomy-for-dentistry/) - [Anticoagulants and antiplatelets before dental extraction](https://durgical.com/en/dentistry/anticoagulants-and-antiplatelets-before-dental-extraction/) [← All of dentistry](https://durgical.com/en/dentistry/) Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once. Sources: [Comparison of Endodontic Failures between Nonsurgical Retreatment and Endodontic Surgery: Systematic Review and Meta-Analysis with Trial Sequential Analysis](https://pmc.ncbi.nlm.nih.gov/articles/PMC9324533/) (Medicina (Kaunas) (PMC open access), 2022); [Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview](https://pmc.ncbi.nlm.nih.gov/articles/PMC4252921/) (Journal of Conservative Dentistry (PMC open access), 2014); [Dental Materials: Biodentine, a Calcium Silicate Bioactive](https://www.ncbi.nlm.nih.gov/books/NBK599506/) (StatPearls Publishing (NCBI Bookshelf), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/dentistry/endodontic-surgery-apicoectomy/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/endodontic-surgery-apicoectomy/