Apical surgery is performed after an unsuccessful root canal. When an infection will not go away or returns after a root canal has been performed this procedure is usually necessary. There are many locations that may contain the infected tissue, so it is difficult to ensure that all of the infection is removed during a root canal. During apical surgery, the tip of the root of the tooth is removed (called an apicoectomy) and replaced with a filling or the infected root is removed and sealed.
In most cases a second root canal is considered before an apical surgery since it is a simpler, less invasive procedure. Before the apical surgery begins you will be given a local anesthetic to numb the area. The doctor will start by making an incision in your gum to expose the root of your tooth. Any inflamed tissue will be removed to clean out the area. The surgery takes place in a very small area, and only a few millimeters are removed from the root or the entire root is removed if it will not affect your ability to use the tooth. For this reason, the doctor will use magnification and small precision instruments to perform the surgery. The precise nature of the surgery gives it a high rate of success. After the root is removed a filling is placed and the gums are sutured. The doctor usually asks that you return to have the sutures removed or to evaluate the healing after surgery. Over the course of the next few months the bone should heal around the root.