Apicectomy (root-end surgery)
A small operation to clean infection from the very tip of a tooth's root and seal it, used as a last chance to save a tooth when root canal treatment has not worked.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It is usually a last attempt to save a tooth after root canal treatment has not cleared infection at the root tip.
- It does not always work — published success is roughly in the region of 75–90%, and depends on the tooth and what treatment came before.
- It is normally a short, day-case operation under local anaesthetic, with stitches out at about a week.
- If it does not work, the usual fall-back is removing the tooth and, if wanted, replacing it with a bridge, denture or implant.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can save a tooth that would otherwise need to be removed
The tooth is too broken down or the supporting bone too poor to be worth saving.
The numbness wears off over a few hours. Expect some swelling and mild soreness. Use any painkillers as advised and avoid disturbing the area.
Clear written instructions on pain relief, mouth care and what is normal in the first days.
The numbness wears off over a few hours. Expect some swelling and mild soreness. Use any painkillers as advised...
Swelling is often at its worst, then starts to settle. Bruising may appear. Eat softer foods and keep the area...
Stitches are usually removed (some dissolve on their own). Most people are back to normal activities and many have...
The tooth firms up as new bone grows around the root. Healing of the bone is checked on an X-ray, sometimes months...
What is an apicectomy (root-end surgery)?
An apicectomy is a small operation that treats infection at the very tip (the apex) of a tooth's root. The surgeon lifts back a little of the gum, removes the infected tissue around the root tip, takes off the end of the root, and places a tiny filling to seal it. The gum is then stitched back.
It is usually done when a root canal treatment has not cleared the infection and re-doing the root canal is not possible or has already failed. It is often described as a 'last chance' to keep the tooth before the alternative — taking the tooth out.
An apicectomy treats infection at the root tip and seals the root. It does not replace a healthy tooth or fix problems in the crown of the tooth, and it cannot guarantee the tooth will last forever. Sometimes the tissue removed is sent to the laboratory to be checked.
Most apicectomies are done by an oral or maxillofacial surgeon, or by a specialist in root canal work (an endodontist), under local anaesthetic while you are awake.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Apicectomy vs other options for a failed root canal
| Option | What it involves |
|---|---|
| Apicectomy | Keeps the tooth; seals the root tip surgically; not always successful |
| Re-do root canal | Non-surgical retreatment through the crown, if the tooth can be re-accessed |
| Take the tooth out | Removes the source of infection; gap can be left, or filled later |
| Extraction + implant/bridge | Replaces the tooth, but is a bigger, separate course of treatment |
Which option suits you depends on the tooth, the previous treatment and your preferences. Ask your surgeon to compare them for your case.
Preparing for your procedure
- See the surgeon or endodontist who will do the operation; they will examine the tooth and look at an X-ray or scan of the root.
- Tell them about your full medical history and all medicines and supplements, especially blood thinners, as some affect bleeding.
- Mention any heart-valve or immune conditions, as you may occasionally need antibiotics beforehand.
- You can usually eat normally before a local-anaesthetic procedure unless told otherwise.
- Plan to take it easy for the rest of the day, and arrange a lift home if you are having sedation.
- Ask whether the tooth has a good long-term outlook, or whether removal might be the more sensible option.
What happens
Most apicectomies are done in a chair or theatre under local anaesthetic, so you are awake but the area is fully numb. The procedure for one tooth usually takes about 45 to 60 minutes.
The surgeon makes a small cut in the gum near the tooth and gently lifts it back to reach the bone over the root tip. The infected tissue is removed, the end of the root is trimmed, and a tiny filling is placed to seal the root. The tissue removed may be sent to the laboratory.
The gum is then stitched back into place. The tooth may feel a little loose for a short time afterwards while new bone grows around the root, then usually firms up again. You can normally go home straight away.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The tooth is too broken down or the supporting bone too poor to be worth saving.
- A repeat (non-surgical) root canal would be safer and more likely to succeed.
- The root tip cannot be reached safely without risking a nearby nerve or sinus.
- Uncontrolled gum disease or a medical condition makes healing or surgery unsafe.
- Removing the tooth, then replacing it, is the more sensible long-term plan.
Delay or rearrange if…
- There is active spreading infection or an abscess that needs settling first.
- Blood-thinning medicines need reviewing before surgery.
- You have an untreated medical problem that affects healing or bleeding.
- Needed imaging (such as a scan to map a nearby nerve) has not yet been done.
- You are unsure and want time to weigh up saving versus removing the tooth.
Alternatives to discuss
- Re-doing the root canal treatment through the crown, if the tooth can be re-accessed.
- Removing the tooth, with the gap left or replaced later.
- Replacing the tooth with a denture, bridge or implant after removal.
- Monitoring with regular review if symptoms are mild and the diagnosis allows.
- An NHS referral pathway rather than private treatment.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can save a tooth that would otherwise need to be removed
- Can clear infection that root canal treatment alone did not reach
- Lets you keep your own tooth rather than having a gap, bridge, denture or implant
- Allows tissue to be sent for laboratory testing if there is any doubt about the diagnosis
- Usually a short, day-case procedure under local anaesthetic
Risks & complications
- Mild swelling and discomfort for a few days, usually controlled with ordinary painkillers
- Bruising inside the mouth, and occasionally on the face
- Some shrinkage of the gum around the tooth, which can show the edge of a crown
- A temporary loose feeling of the tooth until the bone heals
- Infection of the surgical site needing antibiotics
- The operation not working, so the tooth still needs to be removed
- Bleeding that takes longer than expected to settle
- Numbness or tingling of the lip, chin or gum if a nearby nerve is irritated (more relevant for lower back teeth, and usually temporary)
- Opening into the sinus when treating upper back teeth
- Damage to a neighbouring tooth or its root
The biggest uncertainty is whether the operation will actually save the tooth, which varies with the tooth and the treatment that came before. For lower premolars and molars, a nerve in the jaw sits close by, so altered sensation of the lip or chin is possible though uncommon; for upper back teeth, the sinus is close. Ask your surgeon how close these structures are in your case and what the realistic chance of success is.
Published figures to discuss
Success and complication figures for apicectomy vary widely between studies because techniques have changed a lot. Older surgery (naked eye, traditional fillings) reported much lower success than modern endodontic microsurgery (operating microscope, ultrasonic tips, materials such as MTA). Results also depend on which tooth is treated, the previous treatment, gum and bone health, and smoking, so any single percentage should be treated with caution.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Overall success (modern endodontic microsurgery) | Pooled success roughly 78% in prospective studies and around 91% in randomised trials over 2+ years in one meta-analysis | Figures vary by study quality and follow-up; older, non-microsurgical techniques reported markedly lower success. | Apical surgery: a review of current techniques and outcome (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Success rate quoted in UK patient leaflets | Often quoted as about 75–85% | A general average; the figure for your tooth depends on its position and previous treatment. | Apical surgery: a review of current techniques and outcome (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Smoking and outcome | Substantially lower success reported in smokers in some series | Smoking is a recognised factor that reduces healing and success. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery from an apicectomy is usually quick. Many people have only mild soreness and swelling for a few days and need little or no time off, though the bone underneath takes months to heal fully.
- Mild soreness and swelling for the first few days
- Some bruising inside the mouth, occasionally on the face
- The treated tooth feeling slightly loose for a short time
- A small dip or change in the gum line near the tooth
Aftercare
- Use any prescribed or recommended painkillers as directed.
- Avoid disturbing the wound with your tongue or fingers, and do not pull the lip down to look.
- Keep the rest of your mouth clean; follow advice on gentle brushing and any mouthwash near the wound.
- Eat softer foods on the treated side for the first few days.
- Avoid smoking, which slows healing.
- Attend to have stitches removed and to have healing of the bone checked later on an X-ray.
- Painkillers at home (as advised)
- Soft foods for the first few days
- Any mouthwash the clinic recommends
- A note of the stitch-removal appointment
- The clinic's contact number for problems
- A plan for what happens if the tooth still needs to come out
Scars and how they heal
An apicectomy is done through the gum inside the mouth, so there is no scar on the face. The gum line near the tooth can change a little, and occasionally the edge of a crown becomes visible if the gum shrinks slightly during healing.
⚠ Get urgent help if…
- Spreading swelling of the face or neck, especially with fever
- Difficulty swallowing or breathing — seek urgent help
- Bleeding from the wound that will not stop
- Numbness of the lip or chin that is not improving
- Increasing pain, pus or a bad taste after the first few days (possible infection)
- Fluid or air passing between the mouth and nose after upper-tooth surgery
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the infection clears, the gum heals, and an X-ray taken later shows new bone forming around the root tip, with the tooth comfortable and functioning. This is not always known straight away — bone healing is judged over months on follow-up X-rays.
An apicectomy cannot promise the tooth will last for life, and a proportion of teeth still go on to need removal. Modern microsurgical techniques report better results than older methods, but success still depends on the individual tooth, the previous treatment and factors such as smoking.
When an apicectomy works, the tooth can last for many years. Published success rates vary widely — older techniques reported around the region of 60%, while modern endodontic microsurgery reports higher figures, often in the region of 80–90% over several years of follow-up. Smoking, the type and position of the tooth, and the state of the supporting bone all affect how durable the result is.
Related tests, treatments or support
An apicectomy is sometimes planned alongside replacing or repairing the crown on the tooth, or after a repeat root canal treatment has been attempted. If the tooth cannot be saved, removal and later replacement (denture, bridge or implant) is a separate course of treatment to discuss.
Follow-up & long-term care
You will usually be seen at about a week to remove stitches and check the gum is healing. The bone takes longer, so a follow-up X-ray is often taken some months later to confirm healing. Report any spreading swelling, persistent numbness or signs of infection straight away rather than waiting.
- Keep up good cleaning around the tooth and regular dental check-ups.
- Attend the follow-up X-ray so bone healing can be confirmed.
- Tell your dentist promptly if the tooth becomes loose, painful or tender again.
Repeat, follow-on and what comes next
- If the operation does not work, the tooth is usually removed rather than the apicectomy simply repeated.
- Repeat apical surgery is occasionally possible but tends to have lower success than first-time surgery.
- Bone healing is judged over months on X-rays, so the final outcome is not known immediately.
- Some teeth that initially seem to heal can flare up again later and need review.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written instructions on pain relief, mouth care and what is normal in the first days.
- A named contact and number for problems such as spreading swelling or persistent numbness.
- A stitch-removal appointment and a planned follow-up X-ray to confirm bone healing.
- An agreed plan, including cost on the private pathway, if the tooth ultimately needs removing.
- Honest review of the result over months rather than declaring success on the day.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether one tooth or several are treated in the same visit
- The seniority of the surgeon or endodontist and whether an operating microscope is used
- The facility fee (chair-side versus a theatre or sedation setting)
- Imaging needed beforehand, such as a small 3D scan (CBCT)
- Any laboratory testing of tissue removed
- Follow-up appointments and the later check X-ray
- Whether sedation is used in addition to local anaesthetic
- The surgeon's or endodontist's fee
- The facility or chair fee and any sedation cost
- Imaging before surgery and the follow-up X-ray
- Any laboratory (histology) fee if tissue is tested
- Stitch removal and review appointments
- What happens, and what it costs, if the tooth still needs removing or the surgery is repeated
- The cancellation policy
On the NHS? Apicectomy is available on the NHS when there is a clinical need, usually via referral to an oral surgery or endodontic specialist; some people use private care for speed or choice of specialist.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting the operation as guaranteed to save the tooth.
- Not discussing the alternatives of re-doing the root canal or removing the tooth.
- Not warning about possible lip or chin numbness for lower back teeth, or sinus opening for upper teeth.
- No clear plan, or cost, for what happens if the tooth still needs removing.
- No arrangement to check bone healing later on an X-ray.
Marketing red flags
- Claims of a 'permanent' fix or that the tooth is 'saved for life'.
- Describing it as 'simple' or 'without risks' without mentioning nerve, sinus or failure risks.
- Pushing surgery when re-doing the root canal has not even been considered.
- Quoting a single high success rate without reference to your specific tooth.
Choosing a specialist safely
- Check the surgeon is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What is the realistic chance this will save my tooth?
- Would re-doing the root canal, or removing the tooth, be a better option for me?
- How close is the nerve or sinus to this tooth, and what does that mean for my risks?
- Will you use a microscope and modern root-end filling materials?
- When and how will you check that the bone has healed?
- What is the plan if the operation does not work?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is an apicectomy done on the NHS or privately?
Does an apicectomy hurt?
How successful is it?
What happens if it does not work?
How long is the recovery?
Could it damage a nerve?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Leeds Teaching Hospitals NHS Trust — Apical surgery Gloucestershire Hospitals NHS — Advice for patients having an apicectomy BAOMS — What is Oral & Maxillofacial Surgery Long-term prognosis of endodontic microsurgery — systematic review & meta-analysis (PMC) Apical surgery: a review of current techniques and outcome (PMC) Neurosensory disturbances after apical surgery of mandibular premolars and molars (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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