Apicoectomy Guide: Surgical Treatment and Recovery for Root-Tip Inflammation That Root Canal Treatment Has Not Cured

Apicoectomy is a surgery in which, when root-tip inflammation has not healed despite root canal treatment or retreatment, the gum is opened, the inflamed tissue at the root tip and part of the root are cut away, and the end is sealed with a biocompatible material. The KDCA National Health Information Portal describes it as surgical endodontic treatment performed when non-surgical root canal treatment cannot solve the problem. It is close to the last step in trying to keep your own tooth, and the condition and position of the root are checked carefully before surgery.

Published 2026-11-08 · Updated 2026-11-08 · DentalStatics editorial team

Key facts

When it is performed	When non-surgical root canal treatment does not solve the problem (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
Surgical method	Gum incision, exposing the root tip, removing inflammation, cutting off part of the infected root, and filling with a biocompatible material (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
Intentional replantation	A method of extracting the tooth, treating the root and filling it with MTA or similar, then replanting it (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
When replantation is considered	When the bone is thick or a clear view is hard to obtain (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)
Examples of root canal-related complications	Swelling, infection, mandibular nerve injury and others (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal)

When is an apicoectomy done?

Root canal treatment cleans the inside of the root canal by inserting instruments from the top of the tooth, so inflammation remaining outside the root tip, or areas the instruments cannot reach because the end of the canal is curved or blocked, are hard to deal with. In such cases the National Health Information Portal explains that surgical endodontic treatment is performed.

Surgery that approaches the root tip directly is also an option when a thick post and crown are already present and retreating from above would carry a large risk of weakening the tooth. Conversely, if the root has split vertically or the jawbone has dissolved so much that the tooth is loose, extraction is often recommended over surgery.

Root-tip inflammation has not healed even after root canal treatment or retreatment
The root canal is blocked or sharply curved, making access from above difficult
Removing the post and crown carries a high risk of damaging the tooth
A lesion such as a cyst remains outside the root tip

How does the surgery proceed?

After local anesthesia, the gum near the root tip of the tooth is incised and reflected, and a little bone is opened to expose the root tip. The inflamed tissue is scraped out and the part of the root tip that is the source of infection is cut away, then the canal at the cut surface is sealed with a biocompatible material so that it does not become infected again.

Finally the gum is placed back and sutured. Before surgery, root length and the positions of the nearby nerve and the empty space of the upper jaw are checked on X-rays or dental CT to make a plan. Lower molars are close to the nerve canal, so depending on position another method may be chosen instead of surgery.

What is intentional replantation?

Along with apicoectomy, the National Health Information Portal introduces intentional replantation as another method. The tooth is carefully extracted, the root tip is treated outside the mouth and sealed with a material such as MTA, and the tooth is replanted in its original place.

It is considered when the bone is thick or a clear view is hard to obtain so that opening the gum to reach the root is difficult. The replanted tooth is sometimes splinted to the neighboring teeth while it settles, and if the tooth breaks during extraction, replantation may not be possible, so it is good to hear the possibilities and risks in advance.

What are recovery and precautions after surgery?

For the first few days after surgery you may have swelling, bruising or throbbing, so taking the prescribed medicine and applying something cold to the surgical area helps. Do not chew on the operated side, and take care that the toothbrush does not touch the area directly until the stitches are removed.

The National Health Information Portal mentions swelling, infection and mandibular nerve injury as complications related to root canal treatment. If swelling gets progressively worse, you have a fever, or sensation in your lip and chin becomes dull, tell the dentist right away. Whether the bone at the root tip is filling in is checked on X-rays after a certain period.

What should you tell the dentist before an apicoectomy?

If you are taking blood thinners, osteoporosis medicine, or medicine for diabetes or heart disease, you must tell them in advance. Depending on the medicine, bleeding or bone healing may be affected, so the timing and method of surgery are sometimes decided after consulting your physician.

Smoking slows recovery of the gums and bone, so it is best to cut down or quit before and after surgery. The tooth extraction entry of the National Health Information Portal also explains that smoking and drinking slow recovery and can cause complications such as infection. On the day of surgery, avoid hot food until the anesthesia wears off and take care not to bite your lip or cheek.

Common myths and facts

Myth: After an apicoectomy the tooth becomes shorter and quickly loosens.

The part cut off is only a portion of the inflamed root tip, so most of the root remains. Before surgery, the remaining root length and jawbone are checked to judge whether the tooth can hold up.

Myth: Root-tip inflammation always means extraction.

In some cases retreatment or apicoectomy can keep your own tooth. Extraction is considered when there is a root crack or severe bone loss.

Frequently asked questions

Is an apicoectomy major surgery?

It is surgery done in a dental office under local anesthesia, and usually you go home the same day without hospitalization. However, time and recovery period vary with position and extent, so it is good to hear a full explanation beforehand.

Can I resume daily life right after surgery?

Most people can return to daily life from the next day, but there may be swelling and pain for the first few days. Strenuous exercise, drinking and smoking can slow recovery, so it is best to avoid them until the stitches are removed.

Can the surgery be done on both front teeth and molars?

Front teeth are relatively easy to access, while molars have multiple roots and are close to the nerve canal or the empty space of the upper jaw, which makes them difficult depending on position. For molars, intentional replantation or other methods are sometimes considered as well.

How do I know if the surgery went well?

It is judged by symptoms disappearing and, after time, by whether bone around the root tip fills back in on X-rays. It is important to take follow-up images on the schedule the dentist sets.

Wouldn't an implant be better than surgery?

If there is a chance of saving your own tooth, conservative treatment is often considered first. The decision is made by comparing root cracks, the amount of remaining bone, and total treatment cost and time, and it is good to have the pros and cons of both methods explained.

References

Korean version →