A root canal resolves the vast majority of infected or damaged teeth. But occasionally (even when a root canal is performed perfectly) infection persists or returns near the tip of the tooth’s root. When that happens, a surgical procedure called an apicoectomy is often the most effective way to save the tooth and avoid extraction.
At St. Petersburg Endodontics, Dr. Randall Hedrick performs apicoectomies using high-powered dental microscopes and 3D cone beam CT imaging that allow him to see and treat the root tip with a level of precision unavailable in most general dental practices.
What is an apicoectomy?
An apicoectomy, also called root end surgery or periapical surgery, is a minor surgical procedure that removes the very tip of a tooth’s root along with any infected tissue surrounding it. The root end is then sealed to prevent bacteria from re-entering the root canal system.
Despite the word “surgery,” an apicoectomy is an in-office procedure performed under local anesthesia. Most patients are surprised by how manageable both the procedure and the recovery are. We have hundreds of five-star reviews to prove it!
Why would I need an apicoectomy if I already had a root canal?
Root canals have a very high success rate, but a small percentage of treated teeth develop persistent or recurrent infection. This can happen for several reasons:
- A canal branch near the root tip was too small or curved to be fully cleaned during the original root canal
- Calcium deposits inside the root blocked complete access to the root tip
- A tiny crack in the root tip is harboring bacteria that irrigation cannot fully eliminate
- The crown or restoration placed after the root canal allowed bacteria to re-enter the tooth over time
In some of these cases, a root canal re-treatment — reopening the tooth and cleaning the canals again — is the first recommended step. But when re-treatment is not possible or has already been attempted without success, an apicoectomy addresses the problem directly at the source.
What does the apicoectomy procedure involve?
Here is what you can expect when you come to St. Petersburg Endodontics for an apicoectomy:
Step 1: 3D imaging and evaluation
Dr. Hedrick begins with a 3D cone beam CT (CBCT) scan to precisely locate the infection, assess the bone around the root tip, and plan the surgical approach. This imaging reveals anatomy that a standard 2D X-ray simply cannot show.
Step 2: Anesthesia
Local anesthesia is administered to completely numb the area. Sedation options, including nitrous oxide and oral sedation, are available for patients who experience dental anxiety.
Step 3: Accessing the root tip
A small incision is made in the gum tissue near the affected tooth, and the tissue is gently folded back to reveal the bone and root tip beneath. Any infected tissue surrounding the root tip is carefully removed.
Step 4: Removing the root tip and sealing the root
Using the dental microscope for maximum precision, Dr. Hedrick removes approximately 3mm of the root tip – the section most likely to harbor the bacteria causing persistent infection. A small cavity is prepared in the cut end of the root, then filled with a biocompatible material that creates a tight seal.
Step 5: Closure and healing
The gum tissue is sutured back into place. Sutures are typically removed in as few as two to three days, and the bone around the root tip heals over the following months. Most patients experience only mild discomfort, which is managed with over-the-counter pain relievers.
Signs you may need an apicoectomy
- Persistent or recurring pain in a tooth that has already been treated with a root canal
- Swelling or a small bump on the gum near a previously treated tooth
- Tenderness when pressing on the gum over the root tip area
- A dark shadow or lesion visible on an X-ray near the root tip of a treated tooth
- A previously treated tooth that feels “off” when biting down
How long is the recovery?
Most patients return to normal activity the day after an apicoectomy. You can expect some mild swelling and tenderness in the area for two to four days, which is easily managed with ibuprofen and ice packs for the first 24 hours. Strenuous exercise and hard or crunchy foods should be avoided for a few days.
Dr. Hedrick will check in with you personally following your procedure and schedule a follow-up appointment to confirm the area is healing well.
Frequently asked questions
Is an apicoectomy painful?
No. The procedure is performed under local anesthesia and most patients feel only pressure, not pain. Post-procedure discomfort is mild and typically resolves within a few days with over-the-counter pain relievers.
How long does an apicoectomy take?
Most apicoectomies at our office are completed in 30 to 90 minutes depending on the location and complexity of the tooth.
Does insurance cover apicoectomies?
Most dental insurance plans that include surgical benefits will cover a portion of an apicoectomy. Our team will verify your coverage before your appointment and review your expected out-of-pocket cost.
What happens if I don’t get an apicoectomy?
An untreated persistent infection at the root tip will continue to destroy surrounding bone and may eventually lead to loss of the tooth. In some cases, the infection can spread. Prompt treatment gives the tooth the best chance of long-term survival.
Ready to find out if an apicoectomy is right for you? Call St. Petersburg Endodontics at (727) 521-2285 or contact us online. We serve patients from St. Petersburg, Clearwater, Largo, Pinellas Park, Seminole, Gulfport, and throughout Pinellas County.
Dr. Randall Hedrick | Board-Certified Endodontist, American Board of Endodontists | Certificate in Endodontics, University of Texas Health Science Center (1993) | 40+ years in practice