When a tooth infection persists despite a root canal, apical surgery, also called apicoectomy, may be recommended to save the tooth. This specialized procedure targets infection at the tip of a tooth’s root, removing diseased tissue and sealing the root to prevent reinfection. While it sounds complex, understanding the process can help you feel confident and prepared.

This step-by-step guide will walk you through what to expect before, during, and after apical surgery, so you know exactly what’s involved and how to care for your smile afterward.

What Is Apical Surgery?

Apical surgery is a minor surgical procedure performed by an endodontist to treat persistent infection at the root tip of a tooth that has already undergone root canal therapy. Unlike a traditional root canal, which works from inside the tooth, apical surgery addresses the infection directly at the root’s apex, preserving your natural tooth and avoiding extraction.

The goal of the procedure is to:

• Remove infected tissue surrounding the root tip
• Excise the tip of the root if necessary
• Seal the root canal from the apex to prevent further infection
• Preserve the natural tooth’s structure and function

Step 1: Consultation and Preoperative Assessment

Before apical surgery, your endodontist will perform a thorough assessment to determine if the procedure is necessary and suitable.

What happens during this stage:

• Medical History Review: Your dentist will review your overall health, medications, and any conditions that could affect healing.
• Dental Examination: The tooth and surrounding gum tissue are examined for signs of infection or structural damage.
• Imaging: Digital X-rays or 3D scans help the endodontist view the root tip, canals, and surrounding bone.

This assessment ensures the procedure is appropriate and helps the specialist plan the surgery precisely.

Tip: Bring a list of any medications you take and mention allergies or previous dental complications.

Step 2: Preparing for the Procedure

Once the apical surgery is scheduled, there are a few things you can do to prepare:

• Plan Recovery Time: Although recovery is typically quick, arranging a day or two off work may help.
• Follow Instructions: Your dentist may advise avoiding certain medications or foods before surgery.
• Maintain Oral Hygiene: Brush and floss as usual, but avoid aggressive brushing near the affected tooth.

On the day of surgery, the endodontist will ensure the area is clean and will provide local anesthesia to numb the surgical site. Sedation may be offered for patients with dental anxiety.

Step 3: The Procedure

Apical surgery is usually performed under local anesthesia and is considered minimally invasive. Here’s a step-by-step look at what occurs:

1. Incision: The gum tissue overlying the infected root tip is carefully opened.
2. Exposure of the Root Tip: The underlying bone is gently removed to expose the apex of the tooth.
3. Removal of Infected Tissue: The endodontist removes inflamed or infected tissue surrounding the root tip.
4. Resection of the Root Tip: If necessary, a small portion of the root tip is removed to eliminate all infection.
5. Sealing the Root: The end of the root canal is cleaned, shaped, and sealed with a biocompatible material to prevent future infection.
6. Suturing: The gum tissue is repositioned and sutured, usually with dissolvable stitches.

The entire procedure usually takes 30–90 minutes, depending on the complexity and the tooth’s location.

Tip: Don’t hesitate to ask your endodontist to explain each step, they want you to feel comfortable and informed.

Step 4: Immediate Recovery

After surgery, it’s normal to experience mild discomfort, swelling, or tenderness near the treated area. Most patients report that pain is manageable with over-the-counter pain medications or those prescribed by the dentist.

Post-operative care tips:

• Ice Packs: Apply to the cheek for 10–15 minutes at a time to reduce swelling.
• Soft Diet: Eat soft foods and avoid chewing near the surgical site for several days.
• Oral Hygiene: Gently rinse with an antimicrobial mouthwash or saltwater as recommended. Avoid brushing directly over the sutures initially.
• Avoid Strain: Refrain from heavy physical activity for the first 24–48 hours.

Most swelling and discomfort subside within a few days. Mild bruising or slight bleeding is normal and usually resolves quickly.

Step 5: Follow-Up Care

Follow-up visits are crucial for ensuring proper healing and long-term success.

• Suture Check: Your dentist will verify that the gum tissue is healing properly. Dissolvable stitches may take 1–2 weeks to fully disappear.
• X-rays: Periodic imaging confirms that the infection has been eliminated and the bone is healing.
• Monitoring: Your dentist may schedule additional checkups over the next 6–12 months to monitor the tooth’s health.

Tips to Maximize Success

Your actions before and after apical surgery can affect how long the tooth lasts. Experts recommend:

• Maintain Excellent Oral Hygiene: Brush and floss daily to prevent reinfection.
• Avoid Smoking: Smoking can slow healing and increase the risk of complications.
• Protect the Tooth: Avoid chewing hard foods on the treated tooth until fully healed.
• Attend Regular Dental Checkups: Early detection of problems can prevent future issues.

With proper care, an apically treated tooth can last decades, preserving function and preventing the need for extraction.

Who Benefits Most from Apical Surgery?

Apical surgery is ideal for patients:

• Who have persistent infection after root canal therapy
• Where retreatment is not possible or has failed
• Who want to preserve their natural tooth rather than opt for extraction and replacement

This procedure is particularly beneficial for molars and premolars that play an essential role in chewing, maintaining bite alignment, and supporting jawbone structure.

Apical Surgery vs. Tooth Extraction

While extraction may be simpler and sometimes unavoidable, apical surgery provides clear advantages:

• Preserves your natural tooth: Avoids the need for dental implants, bridges, or dentures.
• Maintains jawbone integrity: Tooth roots stimulate the bone and prevent shrinkage.
• Supports bite alignment: Keeps surrounding teeth in proper position.
• Reduces long-term costs: Avoids the expense of replacing missing teeth.

Extraction is still an option when the tooth is severely damaged or fractured, but apical surgery gives many patients a second chance to keep their natural smile.

Final Thoughts

Apical surgery is a safe, effective, and minimally invasive solution for persistent tooth infections that can’t be resolved with conventional root canal therapy. By understanding what to expect before, during, and after the procedure, patients can approach treatment with confidence and know how to care for their smile for long-term success.

If you’ve had a root canal but are experiencing ongoing discomfort or infection, consulting an endodontist about apical surgery may save your natural tooth and prevent the need for extraction.

Preserve Your Smile with Expert Care

At The Endodontic Office, our specialists are trained in advanced apical surgery techniques to ensure your procedure is comfortable, precise, and long-lasting. We prioritize saving natural teeth whenever possible, helping you maintain oral health, function, and confidence.

Call us today to schedule a consultation and find out if apical surgery is the right solution for your persistent tooth infection.