Apicoectomy

An apicoectomy is a surgical endodontic procedure in which the tip of a tooth’s root is removed and the end of the root canal system is sealed to treat persistent periapical pathology or inaccessible canal anatomy after conventional root canal treatment. The goal is to eliminate infection and protect the tooth while preserving natural dentition.

Indications for an apicoectomy include persistent periapical radiolucency after root canal therapy, recurrent or escalating symptoms, a fractured or curved root tip that cannot be adequately treated non-surgically, or when retreatment of the canal is not feasible due to anatomical constraints. It is considered when preserving the tooth is preferable to extraction and restoration.

The procedure typically involves local anesthesia and a small mucoperiosteal flap to expose the bone over the root tip. The surgeon removes a few millimeters of the root apex, cleans and shapes a small retrograde cavity, and fills this cavity with a biocompatible root-end filling material such as mineral trioxide aggregate (MTA) or similar cements. The soft tissue is sutured, and postoperative instructions are provided. Healing is monitored radiographically over months to years.

Alternative treatments include nonsurgical retreatment of the root canal, extraction with a replacement option (implant or bridge), or observation in certain cases. Contraindications include non-restorable teeth, insufficient periodontal support, or extensive infection that compromises surgical success.

Outcomes vary with tooth type, lesion size, and operator experience. Reported success rates range broadly, but many studies indicate a favorable prognosis when appropriately selected and performed. Potential risks include nerve or sinus injury, root fracture, infection, and postoperative pain.