An apicectomy is a surgical procedure in which the
root-tip of a tooth is removed and the truncated root-
tip is hermetically sealed with a root-filling.An apicectomy (also known as surgical endodontics, apical surgery or peri-radicular surgery) should be
considered only when conventional endodontic root filling
(‘root canal treatment’) techniques have failed.

A conventional endodontic treatment is indicated if the dental pulp (‘nerve’) of a tooth becomes non-vital (dies) or
is likely to be put at risk due to the type or size of
restoration needed to repair the tooth.

During endodontic treatment, the dentist removes the dead
remnants of the dental pulp and replaces it with an inert
filling material which is visible on an X-ray.

As there is good evidence that endodontic re-treatment
has higher success rates than apical surgery, patients are
advised to pursue a non-surgical treatment if root canal
treatment is initially unsuccessful

Most teeth will respond satisfactorily to this type of
treatment and become symptom-free.
Apicectomy / Surgical Endodontics – What Is It?

  1. To achieve what could not be done by endodontic re-treatment such as:

Apicectomies ARE NOT done on:

  • Teeth that have been previously apicected (low success rate for repeat apicectomies)
  • Molar teeth (difficult access, low success rate and potential problems with nerves & sinuses)
  • Patients who have poor oral hygiene, active gum disease or uncontrolled toothdecay
  • Teeth where the post-crowns do not fit the root canal or the post has been re-cemented on more than 1 occasion
  • Teeth where there is little tooth substance left to place a crown on afterwards
  • Teeth which have post-crowns that can be removed to allow re-treatment
  • Patients who require intravenous sedation / general anaesthesia
  • Patients at risk from bacterial endocarditis or with blood clotting disorders

There is increased difficulty of the operation due to anatomical & dental anatomical
considerations, such as:

  • Mouth Anatomy. Small oral opening, a prominent chin, Inferior Alveolar & Mental Nerves, active facial & mouth muscles, bony prominences (such as thezygomatic process; anterior nasal spine, external oblique ridge) and a shallow ‘trough’ (vestibule) between the teeth, cheek and lips can hamper the operation.
  • Jaw Bone Thickness. The jaw bone is thicker in the root tip region and more difficult access to the root end
Upper Premolars / Bicuspids, complicated by:
  • Multiple Roots are present that often diverge widely from each other (making access for the procedure difficult and hence lower success rate for op)
  • Sinus Floor can often be in close proximity to the tooth tips that are being operated on. There is a chance of perforating into the sinus (10 – 50% of cases) and causing acute ± chronic sinusitis (especially if any debris has goneinto the sinus).
  • Root Anatomy is such that they are often difficult to get a good root canal filling (due to isthmus / anastomosis of the root systems). Hence, the chancesof success of the apicectomy will be reduced.
Lower Incisors & Canines / Eye-Teeth (Upper & Lower), complicated by:
  • Root Anatomy. Long and broad roots, that are in proximity to adjacent roots and tilted towards either the roof of the mouth (if upper) or the floor of the mouth (if lower) (making access for the procedure difficult and hence lower success rate for op).