The word “surgery” freaks people out. I get it. But an apicoectomy is a lot less scary than it sounds.
When patients at our Torrance office hear me say “endodontic surgery,” I can see the anxiety hit. Their shoulders tense up. They start gripping the armrest. So let me put your mind at ease — this is a small, focused procedure. It’s not what most people picture when they think of surgery.
Let me walk you through it like I would if you were sitting in my chair.
What Is an Apicoectomy, Exactly?
Here’s the simplest way to think about it. Your tooth has a root that anchors into your jawbone. At the very tip of that root, there’s an opening where nerves and blood vessels enter the tooth. Sometimes, infection sets up camp right at that tip — and a regular root canal can’t fully get rid of it.
An apicoectomy removes just the very tip of the root (usually about 3 millimeters) along with any infected tissue around it. Then I place a small filling at the end to seal things off.
That’s it. We’re not removing the tooth. We’re not doing anything to the crown you can see. We’re just cleaning up the end of the root where the problem is hiding.
Think of it this way: A root canal works from the top down, cleaning the inside of the tooth. An apicoectomy works from the bottom up, treating the root tip directly when the top-down approach wasn’t enough.
When Do You Actually Need One?
Not every tooth that had a root canal needs an apicoectomy. Most root canals work great and last for years. But sometimes things don’t go as planned.
Here are the most common reasons I recommend this procedure:
A Root Canal That Didn’t Fully Heal
Sometimes a root canal is done perfectly, but the infection at the root tip just won’t go away. It happens. The anatomy of root tips can be incredibly complex — tiny branches and side canals that even the best instruments can’t reach from the inside.
Retreatment Isn’t an Option
If your tooth already has a post and crown, taking those apart to redo the root canal could damage the tooth. In cases like this, going in through the gum to treat the root tip directly makes a lot more sense. We save the crown, save the post, and still fix the problem.
Persistent Infection at the Root Tip
You might see a small dark spot on an X-ray at the end of a root. That’s a sign of infection or a cyst. If it’s not going away on its own, an apicoectomy clears it out and gives the bone a chance to heal.
Good news: Most patients who need an apicoectomy are good candidates for the procedure. If the tooth has solid bone support and the rest of the root is healthy, the odds of saving it are very much in your favor.
What Happens During the Procedure — Step by Step
I like my patients to know exactly what’s going to happen. No surprises.
Numbing
We use local anesthesia, same as you'd get for a filling or root canal. The area around the tooth is completely numb before anything else happens. You're awake, comfortable, and won't feel pain.
Small Incision in the Gum
I make a small opening in the gum tissue near the root tip. This lets me see the bone underneath and access the end of the root directly.
Remove the Infected Root Tip
Using the microscope, I remove about 3mm of the root tip along with any infected or inflamed tissue surrounding it. I also clean out any cyst that may have formed.
Place a Retrograde Filling
A small biocompatible filling is placed at the cut end of the root to seal it. This prevents bacteria from getting back in. Think of it like putting a tiny cap on the bottom of the root.
Stitch It Up
The gum tissue is placed back and stitched closed. These stitches are small and usually come out in about a week.
The whole thing takes about 30 to 60 minutes per tooth. Most patients tell me it was way easier than they expected.
Recovery — What to Actually Expect
I’m going to be straight with you. There will be some swelling. But it’s manageable, and most patients feel pretty normal within a week or two.
Here’s a realistic timeline:
Day 1-2: Some swelling and mild discomfort. Ice packs are your best friend — 20 minutes on, 20 minutes off. Over-the-counter pain medication like ibuprofen handles it for most people. I’ll prescribe something stronger if needed, but most patients don’t need it.
Day 3-5: Swelling starts going down. You’re eating soft foods — think pasta, scrambled eggs, smoothies. Nothing too hot. Nothing crunchy.
Day 7-10: Stitches come out (a quick, painless visit). You’re starting to feel like yourself again.
Week 2-3: Most patients are fully back to normal. The gum tissue has healed on the surface, though the bone underneath continues to heal over the next several months.
What to avoid after surgery: Don’t brush directly over the surgical site for the first few days. Don’t smoke — it seriously slows healing. Skip hard, crunchy, or spicy foods for at least a week. And try not to pull your lip down to look at it every five minutes (I know it’s tempting).
How Successful Is an Apicoectomy?
This is the part that usually makes patients feel better.
Modern apicoectomies have success rates above 90% when performed with microsurgical techniques. That’s a big jump from how things used to be done. The old-school approach — without microscopes, without ultrasonic instruments, without advanced filling materials — had significantly lower success rates. That’s not how we do it anymore.
Apicoectomy vs. Pulling the Tooth
This is the question I get most often: “Should I just have the tooth pulled and get an implant instead?”
It’s a fair question. Here’s how I think about it.
An apicoectomy saves your natural tooth. Your own tooth, with its own root and its own ligament connecting it to your jawbone. No implant, no matter how good, can perfectly replicate that.
Extraction and implant placement is a longer road. You’re looking at the extraction, possible bone grafting, 3 to 6 months of healing, implant surgery, more healing, and then the final crown. That’s potentially a year of treatment and significantly more cost.
| Factor | Apicoectomy | Extraction + Implant |
|---|---|---|
| Keeps natural tooth | Yes | No |
| Treatment time | Single appointment | 6–12 months |
| Typical cost | $1,000–$1,500 | $4,000–$6,000+ |
| Success rate | 90%+ | 95% |
| Recovery | 1–2 weeks | Multiple healing phases |
If the apicoectomy doesn’t work? You can still extract and place an implant later. But if you pull the tooth first, there’s no going back. You can’t un-extract a tooth.
My general philosophy: If there’s a reasonable chance to save the natural tooth, I think it’s worth trying. Implants are a great backup plan, but they should be a backup plan — not the first option.
Why Modern Apicoectomies Are Different
If you had a friend or parent who had an apicoectomy 20 years ago, they might have a horror story. I hear those stories all the time in our Torrance office. But the procedure has changed dramatically.
The Microscope Changes Everything
I perform every apicoectomy under a surgical microscope with up to 25x magnification. That means I can see the tiniest details of the root tip — cracks, extra canals, the exact boundary of infection. Without the microscope, you’re basically working by feel. With it, you’re working with precision.
CBCT 3D Imaging
Before I even pick up an instrument, I’ve already mapped out the root in three dimensions using our CBCT scanner. I know exactly where the root tip is, how close it is to neighboring structures, and what the infection looks like. No guesswork.
Better Materials
The filling materials we use now (bioceramics) bond to the root and actually promote healing. They’re a huge upgrade from what was available even 10 years ago.
These advances are a big part of why success rates have climbed above 90%. It’s a different procedure than what your parents might have experienced.
Who Performs an Apicoectomy?
Apicoectomies are a specialty procedure. They should be done by an endodontist — a dentist who completed two to three additional years of training focused on saving teeth. This is what we do every day.
My training included extensive microsurgical techniques, and I’ve performed hundreds of these procedures at our Torrance practice for patients across the South Bay. Your general dentist is great at many things, but this is one of those procedures where specialist training and equipment make a real difference in the outcome.
Still Have Questions?
If your dentist mentioned an apicoectomy and you’re not sure what to think, come talk to us. I’ll show you the CBCT scan, explain exactly what’s going on with your tooth, and give you an honest recommendation. If the tooth isn’t worth saving, I’ll tell you that too.
Call (310) 378-8342 to schedule a consultation at Phan Endodontic Partners in Torrance. Let’s figure out the best plan for your tooth.