Dentists
Apical microsurgery
Microsurgical endodontics for cases where non-surgical retreatment is not the right answer or has been exhausted.
Modern apical surgery uses an operating microscope, ultrasonic retro-preparation, and bioceramic root-end filling. It is a small, precise procedure that targets the root apex and surrounding lesion, not the body of the tooth.
I consider apical surgery when non-surgical retreatment is not feasible, when access through an existing post-and-crown is hostile, or when persistent pathology has not responded to a well-executed orthograde re-treatment.
What happens
- Pre-surgical CBCT review of root anatomy and adjacent structures.
- Microsurgical flap design, osteotomy, and apical resection.
- Ultrasonic retro-preparation and bioceramic root-end filling.
- Structured follow-up imaging and recall to monitor healing.
When to consider
- A previously well-treated tooth with persistent or enlarging apical pathology.
- Anatomical or restorative reasons that make orthograde retreatment hostile.
- Iatrogenic findings such as a perforation that is best managed surgically.
- Selected biopsy needs alongside endodontic management.
Surgical endodontics is not a rescue for poor restorative prognosis. I discuss strategic value with the referring clinician before recommending it.
The information here is general dental education, not a personal clinical diagnosis. Individual outcomes vary and depend on factors specific to your tooth and your overall health.
Common questions
Questions about this treatment
When is apical surgery needed?
Surgery is considered when conventional root canal treatment cannot resolve persistent infection — for example, when a persistent cyst, calcified canal, or procedural complication prevents adequate cleaning from above.
What does apical microsurgery involve?
Under local anaesthetic, a small incision exposes the root tip. The infected tissue and tip of the root are removed, and the canal end is sealed with a biocompatible material. The procedure is done under the operating microscope for precision.