# Apicectomy: surgery at the tip of a root

> What an apicectomy is, why infection can persist at the root tip of a root-filled tooth, how the operation proceeds, its risks and the alternatives. General information.

Source: https://www.nazemalioussef.com/en/clinical-interests/apicectomy/  
Updated: 2026-09-28

Clinical interest

An apicectomy is a small operation for an infection that remains at the tip of a root after root canal treatment. The very end of the root is removed with the infected tissue around it, and the root end is sealed with a small filling.

From the professional website of Dr Nazem Al Ioussef Published 27 September 2026 Last reviewed 27 September 2026

## What an apicectomy is

An apicectomy is also called root-end surgery, root-end resection or periapical surgery, and it is one form of endodontic surgery. It deals with the tissues around the tip of the root, the apex. Root canal treatment reaches the canals through the top of the tooth; an apicectomy reaches the root tip from the side, through the gum and the bone.

The aim is to remove the source of a persistent infection and to seal the end of the root canal, so that the bone around the root tip can heal and the tooth can be kept.

## Why infection can remain after root canal treatment

After root canal treatment, the bone around the root tip usually heals. Sometimes an infection persists or comes back. Common reasons include:

- bacteria in a part of the root that could not be reached, such as a very narrow, curved or branching canal;
- a canal that was blocked by calcified tissue or by a broken instrument, or one that was missed;
- a leaking filling or crown that has let bacteria back into the tooth;
- a crack in the root.

There may be tenderness when biting, swelling, a bad taste, or a small spot on the gum that discharges from time to time. Quite often there are no symptoms at all, and the problem shows on an X-ray as a dark area around the root tip.

## When surgery is considered

For a root-filled tooth with a persistent infection, the usual first step is re-treatment: the tooth is reopened, the old root filling is removed, and the canals are cleaned and filled again. An apicectomy is considered when:

- re-treatment has been done and the infection has persisted;
- re-treatment through the crown is not possible or carries too much risk, for example because of a post in the root, or a crown or bridge that would have to be cut off;
- a blockage or a broken instrument stops the canal from being cleaned to its end;
- the dentist needs to look at the root surface, for instance to check for a crack.

Surgery does not suit every tooth. A root with a vertical crack, a tooth with little bone support or a tooth that cannot be restored is often better removed. Upper back teeth near the sinus and lower back teeth near the nerve need careful assessment, often with a three-dimensional scan.

## How the procedure usually proceeds

### Apicectomy in three stages

1. **Persistent infection.** Infection remains at the root tip of a tooth that has had root canal treatment.
2. **Root tip removed.** Through a small opening in the gum and bone, the root tip and the infected tissue around it are removed.
3. **Root end sealed.** The end of the root is sealed with a small filling, and the bone heals around it.

Simplified drawing, not to scale.

1. **Assessment.** An examination and X-rays, often with a cone-beam CT scan, to see the root, the infected area and any nearby nerve or sinus.
2. **Anaesthetic.** A local anaesthetic numbs the area. Sedation is sometimes used, and occasionally a general anaesthetic.
3. **Access.** A small cut is made in the gum and the gum is lifted back. A small window is made in the bone over the root tip.
4. **Removing the infection.** The infected tissue is cleaned away and the very end of the root is removed. Magnification, often an operating microscope, helps the dentist see the root.
5. **Sealing the root end.** The end of the canal is cleaned a short way in and sealed with a small filling of a material that the body tolerates well.
6. **Closing.** The gum is stitched back into place. Some stitches dissolve; others are removed at a review. A later X-ray shows how the bone is healing.

## Risks and limits

Discomfort, swelling and bruising are common after the operation, and bruising can show on the face. Less often:

- the wound becomes infected, or bleeds after the patient has gone home;
- the lip, chin, gum or tongue feels numb or tingles when the tooth lies close to a nerve. This is usually temporary, but occasionally long-lasting;
- with upper back teeth, an opening forms into the maxillary sinus. It usually heals, but it can cause sinus symptoms;
- the gum shrinks slightly as it heals, which can expose the edge of a crown;
- the tooth feels slightly loose until the bone has healed;
- the infection persists or returns, and the operation is repeated or the tooth is removed.

An apicectomy is a way of trying to keep a tooth, and it cannot promise that the tooth will be kept. The chances depend on the tooth, the size of the infection and the quality of the seal, and the dentist explains them for each case.

## The alternatives

The main alternatives are re-treatment of the root canal, where that is possible, and removal of the tooth. After an extraction the gap can be left, or filled with a bridge, a denture or an [implant](https://www.nazemalioussef.com/en/clinical-interests/dental-implants/). Keeping a natural tooth that can be saved is generally preferred, but the choice depends on the tooth, the bone around it and the patient's wishes.

## After the operation

The dentist gives written aftercare advice. It usually includes pain relief as recommended, a cold compress on the cheek, soft food and chewing on the other side, gentle brushing near the stitches, warm salt-water rinses if advised, and not smoking. After surgery on an upper back tooth, the dentist may advise against blowing the nose hard for a while. Swelling that spreads or gets worse, a fever, or bleeding that does not stop with firm pressure should be reported to the dentist promptly.

Most teeth never need surgery. An apicectomy comes after [root canal treatment](https://www.nazemalioussef.com/en/patient-guides/root-canal-treatment/), and a well-sealed filling or crown on a root-filled tooth helps keep bacteria out of the canals.

## Questions patients ask

**Is an apicectomy the same as root canal treatment?**

No. Root canal treatment cleans the canals from inside the tooth, through the crown. An apicectomy reaches the tip of the root from outside, through the gum and bone, and is usually considered only after root canal treatment has been done.

**Does an apicectomy hurt?**

It is usually done under local anaesthetic, so the area is numb; pressure may be felt during the procedure. Discomfort, swelling and some bruising are common for a while afterwards, and the dentist advises on pain relief.

**Will the tooth be weaker afterwards?**

Only the very end of the root is removed, so most of the root stays in the bone. The tooth can feel slightly loose at first and usually firms up as the bone heals. A tooth whose root is already short, or which has little bone around it, may not be suitable for surgery.

**How is healing checked?**

The dentist usually takes an X-ray at a later review to see whether bone is filling in around the root tip. Bone heals slowly, and how long it takes differs from person to person.

**What happens if the infection comes back?**

Sometimes the operation can be repeated. In other cases the tooth is better removed, and the gap can be left or filled with a bridge, a denture or an implant. The options are discussed at a review.

## What this page rests on

This page rests on published patient information from the Oral Health Foundation, an NHS hospital trust and the American Association of Endodontists, and on the European Society of Endodontology's clinical practice guideline, listed below. Whether a particular tooth is suited to surgery, to re-treatment or to neither can only be judged at an examination with X-rays.

General health information, not a diagnosis or a treatment recommendation for any individual.

### Sources

1. Oral Health Foundation — [Apicectomy](https://www.dentalhealth.org/apicectomy)
2. Gloucestershire Hospitals NHS Foundation Trust — [Advice for patients having an apicectomy](https://www.gloshospitals.nhs.uk/your-visit/patient-information-leaflets/advice-for-patients-having-an-apicectomy/)
3. American Association of Endodontists — [Endodontic surgery explained](https://www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-surgery/endodontic-surgery-explained/)
4. Duncan HF, et al. (2023) — [Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J 56 Suppl 3](https://doi.org/10.1111/iej.13974)
5. NHS — [Root canal treatment](https://www.nhs.uk/tests-and-treatments/root-canal-treatment/)

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