Generally, a root canal is all that is needed to save teeth with injured pulp from extraction. Occasionally, this nonsurgical procedure will not be sufficient to heal the tooth and surgery will be recommended. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on X-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

Endodontic surgery is usually called for under the following circumstances:

  • Diagnosis of canals and inner tooth structures that cannot be performed non-surgically.
  • Conventionally blocked root tips.
  • Cracked roots.
  • Perforated root tips.
  • Persistent cysts.
  • Removal of a debris from a previous root canal.
  • Unusually formed teeth which often have complex canal divisions that cannot be treated with conventional endodontic treatment.


An apicoectomy is often performed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure.  An apicoectomy often involves removal of the end of the root of the tooth.  During the procedure, the gingival (or gum) tissue near the tooth is opened with an incision. This allows the underlying bone to be examined and inflamed or infected tissue to be removed.  Afterwards, a small filling may be placed to seal the end of the root canal, and a few stitches or sutures are placed in the gum tissue to aid healing.