Apicoectomy · Makati

Apicoectomy

Apicoectomy — also called root-end surgery — is the surgical removal of the tip of a tooth root along with any infected tissue around it. It is typically the last option to save a tooth when conventional root canal treatment has not resolved the infection.

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At a glance

Root-end surgical treatment
For persistent infection after root canal
Local anaesthesia, typically single visit
Aim is tooth preservation
Healing typically 1–2 weeks soft tissue, months for bone
Overview

When conventional root canal has not been enough

Most teeth with infected pulp can be successfully treated with conventional root canal treatment, which cleans and seals the canals from inside the tooth. Occasionally — perhaps 5 to 10 percent of cases — the infection persists despite well-performed treatment. The bacteria may have penetrated the bone around the root tip, formed a cyst, or hidden in an anatomical complexity that the canals could not reach.

Apicoectomy approaches the problem from the other side. The treating dentist accesses the root tip through the gum and bone, removes the apex (the last few millimetres of the root), removes any infected tissue around it, and seals the cut end of the root with a biocompatible filling. The tooth itself remains, the original crown stays, and the structure is preserved.

It is a tooth-saving surgery — the alternative is usually extraction followed by a dental implant or bridge. Where apicoectomy is appropriate, it is the more conservative option.

When It Is Considered

Who is a candidate for apicoectomy?

Apicoectomy is usually considered when one or more of the following apply:

Persistent infection or pain after a completed root canal
A persistent radiographic lesion at the root tip after treatment
Re-treatment of the root canal is not feasible
An existing crown the patient wishes to preserve
Anatomical complexity (curved canals, accessory canals) blocking conventional retreatment
Cyst formation at the root tip identified on imaging
When apicoectomy is not the right answer Severe tooth structure loss, vertical root fracture, or extensive bone loss around the tooth typically rule out apicoectomy in favour of extraction and replacement. The treating dentist will be plain about which category your tooth falls into.
The Process

What the surgery involves

1

Assessment and Imaging

Clinical examination, targeted intraoral radiographs, and a discussion of the alternatives — including retreatment of the root canal, apicoectomy, and extraction. The case for surgery is made when retreatment is not feasible or has already failed.

2

Local Anaesthesia

The area is fully numbed before any incision. Apicoectomy is performed under local anaesthesia in almost all cases — there is no need for general anaesthesia in routine cases.

3

Access and Root-End Resection

A small flap of gum is raised to access the bone over the root tip. A small window is made in the bone to expose the apex. The last few millimetres of root are removed, and any infected tissue around it is carefully cleaned away.

4

Retrograde Seal

The cut end of the root is sealed with a biocompatible material — typically MTA (mineral trioxide aggregate) or a similar cement — to prevent bacteria re-entering from the canal side. This is the critical step that gives the surgery its long-term success.

5

Closure

The gum flap is replaced and sutured. Soft tissue healing typically takes 1 to 2 weeks; the bone fills in over several months and is monitored on follow-up radiographs.

6

Follow-Up and Healing Review

Sutures are removed at 7 to 10 days. Radiographic review at 6 months confirms the bone is healing. Most apicoectomies show clear resolution of the lesion at 12 months.

Why DevelopDent

How DevelopDent approaches apicoectomy

Tooth-saving as the goal
The treating dentist's surgical training is oriented toward preserving natural teeth where the prognosis supports it. Apicoectomy is the surgical extension of that philosophy — favoured over extraction when the rest of the tooth is sound.
Atraumatic surgical technique
Careful flap design, controlled bone access, and precise root-end management. Patients regularly note minimal post-operative swelling and discomfort — a direct outcome of meticulous execution.
Honest scope
Where the case is borderline or beyond what general-practice apicoectomy can reliably resolve, the treating dentist will refer to an endodontist or maxillofacial surgeon. Pursuing a low-probability surgery on a borderline tooth is not a sound recommendation, and DevelopDent will say so.
Integrated planning
If apicoectomy is unlikely to succeed and extraction is the more honest path, the conversation about implant or bridge replacement starts at the same visit — not weeks later when the tooth has already failed.
Frequently Asked Questions

Common questions about apicoectomy

Is apicoectomy painful?
The procedure is performed under local anaesthesia and should not be painful during surgery. Mild swelling and tenderness for 3 to 5 days afterward is normal and managed with over-the-counter analgesics. Most patients describe recovery as easier than they expected.
How successful is apicoectomy?
Modern microsurgical apicoectomy with biocompatible root-end materials has reported success rates above 85% in appropriately selected cases. Success depends most on case selection — a borderline tooth has lower success regardless of technique.
Will I need a new crown afterward?
In most cases, no. The existing crown is preserved because the surgery is performed through the gum and bone, not through the top of the tooth. This is one of the advantages of apicoectomy over conventional retreatment for teeth that already have a crown.
What is the alternative if apicoectomy is not appropriate?
Extraction of the tooth, followed by replacement with a dental implant or bridge. The treating dentist will be honest about which pathway gives the better long-term outcome for your specific case.
How long is the appointment?
Typically 60 to 90 minutes from local anaesthesia to suture placement. Single-tooth apicoectomy is a single-visit procedure.
Can I drive home after?
Yes — apicoectomy under local anaesthesia does not affect your ability to drive. Most patients return to work the following day, depending on the demands of the role.

Legazpi Village,
Makati

DevelopDent is located on the ground floor of Legaspi Tower 200 on Paseo de Roxas — a short walk from Greenbelt and accessible from across Makati CBD, Salcedo Village, and BGC.

Directions and getting here →
Address

1st Floor, Legaspi Tower 200
107 Paseo de Roxas Street
Legazpi Village, Makati, 1229

Nearest Landmarks

Legazpi Village · near Greenbelt
Ayala Triangle · Salcedo Village

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Save the tooth when there's a reasonable path to save it

An apicoectomy consultation at DevelopDent assesses whether the tooth is worth preserving with surgery, or whether extraction and replacement is the more honest path. You leave with a clear recommendation and the reason behind it.

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