An Apicoectomy is the most common endodontic surgical procedure used to save a tooth. This treatment is done when inflammation persists in the bony area around the end of your tooth after a root canal procedure. This infection is known as an abscess and will not go away without proper treatment.
This is a microsurgery that the doctor will perform under the microscope, remove any underlying bone and inflamed or infected tissue, We send the biopsy to be tested. This Endodontic Surgical procedure is a good way to save the tooth or crown, because no hole will be made through the crown of the tooth. A small filling is placed to seal the end of the root canal, and a few stitches are placed in the gum to help the tissue heal. Over a period of months the bone fills in the area at the end of the root.
After the treatment is done we will follow up with you in six months to make sure the bone has grown back properly.
Microsurgical Precision When Root Canals Aren’t Enough
Sometimes, even the best root canal treatment isn’t sufficient. Persistent infection at the root tip, anatomy that prevents complete cleaning, or complications from previous treatment may require a surgical approach. Apicoectomy, also called root-end surgery, removes the source of infection while preserving your natural tooth.
Understanding When Surgery Becomes Necessary
Root canal treatment cleans infection from inside your tooth. Occasionally, bacteria persist in areas we cannot reach from above:
- Infected tissue outside the root tip
- Cysts that won’t heal with conventional treatment
- Complex anatomy at the root apex
- Bacterial biofilm on the root surface
- Foreign material pushed beyond the tooth
Think of it this way: if root canal treatment is like cleaning your house from the inside, apicoectomy is addressing problems in the foundation that you can’t reach through the front door.
Modern Microsurgery vs. Traditional Surgery
Traditional apicoectomy had a mixed reputation, with success rates around 60%. Modern microsurgical techniques achieve 85-95% success. The difference? Precision that wasn’t possible before.
Our surgical microscopes provide up to 25x magnification with coaxial illumination. We see individual tubules in your root structure. Ultrasonic instruments measuring fractions of millimeters allow precise preparation. Biocompatible materials like MTA (developed by Dr. Torabinejad, who has lectured at our facility) create superior seals.
This isn’t your grandfather’s oral surgery. It’s minimally invasive precision that preserves maximum tissue while eliminating disease.
The Microsurgical Process
Pre-Surgical Planning
CBCT imaging shows us exact root anatomy, lesion size, and proximity to vital structures. We know precisely what we’ll encounter before making the first incision. This planning means smaller surgical sites and faster healing.
The Procedure
Under local anesthesia (you’re completely numb but awake), we:
- Create a small access flap in the gum tissue
- Remove minimal bone to expose the root tip
- Remove 3mm of root apex at a precise angle
- Prepare a micro-cavity using ultrasonic instruments
- Place biocompatible filling material to seal the canal
- Close with microsurgical sutures
The entire procedure typically takes 30-60 minutes.
Advanced Techniques
We use piezoelectric surgery when near vital structures like nerves or sinuses. This technology cuts bone but not soft tissue, providing an extra margin of safety. Platelet-rich fibrin from your own blood accelerates healing when indicated.
Recovery and Healing
Modern microsurgery means minimal discomfort. Most patients:
- Return to work the next day
- Manage any discomfort with over-the-counter medication
- Experience peak swelling at 48-72 hours (usually mild)
- Have sutures removed in 3-5 days
- Show complete bone healing in 6 months
We provide detailed post-operative instructions and call you that evening to check your comfort.
Success Factors and Prognosis
Apicoectomy success depends on several factors:
- Initial healing (6-12 months): 85-95% show complete healing
- Long-term success (5+ years): 80-90% remain successful
- Tooth type: Front teeth have highest success rates
- Pre-existing conditions: Larger lesions take longer but heal well
Failed apicoectomies can sometimes be retreated surgically or extraction becomes necessary. We discuss realistic prognosis before any procedure.
When Apicoectomy Is Your Best Option
Consider surgical treatment when:
- Conventional root canal retreatment isn’t feasible
- Persistent symptoms despite adequate root canal therapy
- Biopsy is needed to rule out pathology
- Procedural errors need surgical correction
- You want to avoid removing a crowned tooth
Alternatives to Consider
Before recommending surgery, we evaluate:
- Non-surgical retreatment: Often our first choice when possible
- Extraction and implant: Sometimes more predictable long-term
- Monitoring: Small lesions might heal without intervention
- Intentional replantation: Extraction, treatment, and replacement
We present all options with honest assessment of success probability.
The Cost-Benefit Analysis
Apicoectomy typically costs $1,200-1,800, often covered partially by insurance. Compare this to extraction and implant at $4,000-6,000. When successful, apicoectomy preserves your natural tooth for decades, avoiding bone loss and maintaining normal sensation.
Our Surgical Experience
Dr. Dianat has performed hundreds of apicoectomies using the latest microsurgical techniques. Our success rates exceed published averages because of:
- Precise case selection
- Advanced imaging and planning
- Microsurgical instrumentation
- Biocompatible materials
- Detailed follow-up protocols
Making the Surgical Decision
We never recommend surgery lightly. If we suggest apicoectomy, it’s because we believe it offers the best chance of saving your tooth. We’ll show you the CBCT images, explain the procedure in detail, and give you time to consider your options.
Schedule a consultation at (949) 622-0055 to determine if apicoectomy could save your tooth.
