Sometimes it is appropriate to consider retreating failing root canal treatment surgically from the root-end instead of retreating through the crown of the tooth. This is referred to as apical surgery, sometimes referred to as "apicoectomy". Indications for apical surgery include:


  1. Persistent, well established infections or cysts,
  2. Cases where retreatment could have undesirable consequences,
  3. Infected canal spaces that are only accessible with surgery.

During apical surgery, the infection is accessed through an incision in the gums. The infected tissue is removed and sent to a pathology laboratory for evaluation. The tip of the root (the apex) is removed which usually contains the source of the problem. A small tunnel is carefully prepared in the root canal and a root-end filling is placed. The gums tissue is closed with sutures which are removed in 3-6 days. With the source of the infection removed the bone can heal.


Historically, success with apicoectomy was unpredictable due to limitations with techniques and materials. Advances in both diagnosis and the surgical techniques, including microscopic visualization and ultrasonic instrumentation, have tremendously increased surgical precision. This has resulted in far better success rates than were previously possible.