Root canal treatment saves the vast majority of teeth it’s performed on, but occasionally a tooth that’s already had a root canal continues to show signs of infection or doesn’t heal as expected. When that happens, the next step often isn’t another root canal — it’s a surgical procedure called an apicoectomy, performed by an oral surgeon in coordination with the treating endodontist.

What an apicoectomy actually is: a minor surgical procedure that removes the very tip of a tooth’s root (the apex) along with any surrounding infected tissue, then seals the root end to prevent further infection. It’s performed through the gum tissue near the tooth, not through the crown, which is what distinguishes it from a root canal itself.

When an endodontist typically refers for this procedure:

• Persistent infection or inflammation at the root tip despite a technically well-performed root canal
• Complex root canal anatomy — like tiny lateral canals or calcified canals — that couldn’t be fully treated through standard root canal instrumentation
• A tooth with a crown or post where reopening the tooth for a repeat root canal would risk damaging the restoration
• Small cysts or lesions at the root tip that need to be removed directly

What the procedure involves: performed under local anesthesia (occasionally with sedation), the surgeon makes a small incision in the gum near the root, removes the infected tissue and root tip, and places a small filling to seal the root end before closing the site with a few sutures. Most patients return to normal activity within a few days, with some swelling and tenderness during initial healing.

Why this partnership matters: an apicoectomy is often what saves a tooth that would otherwise need extraction, preserving your natural tooth and avoiding the additional cost and time of an extraction followed by implant replacement.

Our oral surgeons at Falcon Implants & Oral Surgery work directly with referring endodontists on these cases, reviewing imaging together to confirm surgery is the right path before proceeding. If your endodontist has mentioned an apicoectomy might be needed, we’re glad to coordinate that referral directly.