Periapical surgery
For an infection at the tip of a root that a root canal, or a second one, has not cleared.
Periapical surgery, usually called an apicoectomy, treats the tip of a tooth's root through the gum instead of through the tooth. It is used when an infection at the root tip will not heal and redoing the root canal from the top is not possible, or has already been tried.
When a root canal is not enough.
- A root-treated tooth is still infected after retreatment.
- The tooth carries a crown on a long post, and taking them out to redo the root canal could split the root.
- A canal is blocked, or bends too sharply to be cleaned to its end from above.
- Follow-up X-rays show an area at the root tip that is not healing, even though the root canal looks sound.
- A lump at a root tip needs a sample taken to find out what it is.
Periapical surgery, step by step.
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01
Planning from the images
Dr. Malik takes X-rays of the root to see how close the tip sits to a nerve, the sinus or the next tooth. Before you agree to anything you hear the other routes too, including taking the tooth out.
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02
Freezing
The area is frozen as deeply as for any surgery, and you can have nitrous oxide with it. You are awake throughout, and a raised hand stops the work.
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03
Reaching the tip
A small flap of gum is folded back and a window is made in the thin bone over the end of the root. The infected tissue is cleaned out and the last few millimetres of the root are trimmed off.
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04
Sealing the end
A small filling goes into the cut end of the canal to close it from below, and the gum is stitched back in place. Anything unusual removed from the tip can go to a lab for testing.
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05
Healing and the check X-ray
Swelling and bruising are worst in the first two days, and a cold pack on the cheek helps. Stitches come out after about a week, and an X-ray some months later shows whether the bone has filled back in.
Periapical surgery and your dental plan.
Periapical surgery is one visit, a short stitch check afterwards, and a follow-up X-ray some months later. It is priced per root, so a two-rooted tooth costs more than a front tooth with one. Many plans that cover root canals pay part of it too.
Ask us what it will costPeriapical surgery, answered.
Is an apicoectomy the same as a root canal?
No. A root canal cleans the tooth from the inside, through the top. An apicoectomy works from outside, through the gum, on the tip of the root where the infection sits, and it usually follows a root canal rather than replacing one.
How painful is an apicoectomy?
The area is frozen, so during the surgery it is pressure rather than pain. Most people find the swelling afterwards bothers them more than the soreness, and ordinary pain relievers usually cover the first few days.
How long does an apicoectomy take to heal?
The gum is comfortable again within a week or two. The bone around the root tip fills in over several months, which is why a check X-ray is taken later.
Why not just pull the tooth?
Sometimes that is the better choice, and Dr. Malik will say so. But the gap then needs an implant, a bridge or a partial denture, and keeping a sound tooth is usually less work and less cost.
