Save your natural tooth with endodontic microsurgery. When a standard root canal isn’t enough to save a tooth, you have a choice: extract the tooth or try to save it with an apicoectomy.
At Cosmetic & Advanced Dentistry in Owings Mills, we don’t give up on natural teeth. Our team, led by a prosthodontist and cosmetic dentist, offers apicoectomy. The procedure is a precise, microsurgical treatment designed to eliminate infection at the root tip and preserve your smile.
For a free consultation, call us today at (410) 697-6290 to see if you are a candidate.
What Is an Apicoectomy? (Root-End Surgery)
An apicoectomy is a minor surgical procedure performed on a tooth that has already had a root canal but remains infected. Think of it as a “root canal from the outside.”
In a standard root canal, the dentist cleans the inside of the tooth. In an apicoectomy, we access the tip of the root through the gum, remove the infected tip, and seal the end to prevent bacteria from re-entering.
Why is it called a root-end resection? “Apico-” refers to the apex (tip) of the root, and “-ectomy” means removal. We are literally removing the tiny infected tip of the root to save the rest of the tooth.
Why Would I Need an Apicoectomy?
Root canal treatments have a high success rate (85-97%). However, sometimes anatomy gets in the way. You might need an apicoectomy if:
- Complex Root Anatomy: Your tooth has tiny, curved, or extra canals that a standard cleaning couldn’t reach.
- Persistent Infection: An abscess or cyst remains at the root tip despite a properly performed root canal.
- Calcified Canals: The root canal is blocked by calcium deposits, making it impossible to re-treat from the inside.
- Existing Restorations: Your tooth has an implant post or dental crown, which makes redoing the root canal risky to the tooth structure.
The Cosmetic & Advanced Difference: Why Choose Us?
At Cosmetic & Advanced Dentistry, we treat the entire tooth, not just the infection. Because we have a prosthodontist (Dr. Doroshenko) and a cosmetic dentist (Dr. Lazer) on-site, your surgical success is paired with aesthetic consideration.
- Precision Technology: We use surgical microscopes and ultrasonic instruments to ensure the procedure is minimally invasive and highly accurate.
- Specialist Expertise: Our team has advanced training in the complex anatomy of the jaw, including its proximity to nerves and sinuses, ensuring your safety.
- One-Stop Care: From the surgery to the final restoration (crown), you never have to leave our Owings Mills office.
The Procedure: What to Expect
We know surgery sounds scary, but an apicoectomy is an outpatient procedure performed right here in our Baltimore dental office.
- Numbing & Comfort: Dr. Ali Eghtesadi will completely numb the area. We also offer sedation options if you feel anxious about the procedure.
- Access: A small incision is made in the gum tissue to expose the underlying bone and root tip.
- Removal: The infected root tip (usually the last 2-3 millimeters) is removed. An ultrasonic instrument cleans the area thoroughly.
- Sealing: A tiny biocompatible filling is placed to seal the end of the root canal, preventing re-infection.
- Sutures: The gum is stitched back into place. The procedure typically lasts 30 to 90 minutes.
Recovery Time & Aftercare
Apicoectomy recovery is generally quick and manageable.
- Immediately After: You may experience mild swelling or bruising, similar to having a wisdom tooth removed. This usually peaks on day two and subsides within a week.
- Pain Management: Over-the-counter pain relievers (like ibuprofen) are usually sufficient to keep you comfortable.
- Diet: Stick to soft foods for a few days and avoid chewing on the side of the surgery.
- Oral Hygiene: Keep the area clean. Your dentist may recommend a warm salt water rinse (do not spit forcefully).
- Return to Work: Most patients return to normal activities within 1 to 2 days.
Apicoectomy vs. Extraction: A Critical Decision
If your root canal has failed, you really have two paths. One saves your natural tooth. The other removes it and starts over.
Choosing an Apicoectomy (Saving Your Tooth)
An apicoectomy preserves your natural tooth. That means you preserve your natural bite and avoid the domino effect that often follows an extraction. There’s no follow-up procedure needed, so you’re done once you heal.
The cost is a one-time surgery fee, usually partially covered by insurance. Recovery involves mild swelling for a few days, but you keep your smile intact.
Choosing Extraction (Removing the Tooth)
Extraction removes the infection by removing the entire tooth. But that creates a new problem. Now you have a gap. To fix that gap, you’ll need either a dental implant (which requires surgery and months of healing) or a bridge (which requires grinding down healthy adjacent teeth).
Either way, you’re looking at thousands of additional dollars and multiple appointments. Recovery from extraction plus implant surgery can take months, not days.
Our recommendation
We always prefer to save your natural tooth whenever possible. An apicoectomy allows you to keep your natural bite and avoids the need for more expensive, more invasive procedures down the road. If we can save it, we will.
Success Rates & Risks
Modern apicoectomy techniques achieve high success rates. Studies show success rates ranging from 85% to 97% when performed with a microscope and modern materials.
As with any surgery, there are minor risks such as infection, bleeding, or nerve irritation (usually temporary). However, complications are rare when the procedure is performed by an experienced provider.
Patient Review
Frequently Asked Questions
Is an apicoectomy painful?
Most patients report very little pain during or after the procedure. You will be completely numb during the surgery, so you shouldn’t feel anything beyond pressure. After the numbness wears off, you might feel mild discomfort, similar to that after a tooth extraction.
Over-the-counter pain relievers like ibuprofen usually manage this very well. Most patients say the recovery is easier than they expected.
How long does an apicoectomy take?
The procedure itself typically takes between 30 and 90 minutes, depending on which tooth is being treated. Front teeth (incisors and canines) are usually on the shorter end because they have single, straight roots. Molars take longer because they have multiple roots and more complex anatomy. Your dentist will give you a clear time estimate during your consultation based on your specific tooth.
How long does an apicoectomy last?
If the procedure is successful, it’s permanent. The infected root tip is removed and sealed, and the rest of your natural tooth remains in place. With good oral hygiene and regular dental check-ups, a tooth that has undergone an apicoectomy can last just as long as any other natural tooth. Many patients keep these teeth for decades or even a lifetime.
Does dental insurance cover apicoectomies?
Yes, most dental insurance plans cover a percentage of apicoectomies because it is considered a standard endodontic surgical procedure to save a natural tooth. Coverage typically ranges from 50% to 80% of the procedure cost, depending on your specific plan. Our office will file all claims on your behalf as an out-of-network provider, and you will receive reimbursement directly from your insurance company.
Can an apicoectomy be done on a molar?
Yes, but molars are more complex. Because molars have multiple roots and curved anatomy, the surgery requires greater skill and more advanced technology. Our Owings Mills office is equipped with surgical microscopes and ultrasonic instruments designed specifically for molar apicoectomies. Dr. Doroshenko’s advanced prosthodontic training means he understands the complex anatomy of back teeth better than a general dentist.
How long is the recovery time after an apicoectomy?
Most patients return to work or normal activities within one to two days. You may experience mild swelling or bruising, which usually peaks around 48 hours after surgery and then begins to subside. You should stick to soft foods for a few days and avoid chewing on the side of your mouth that was operated on. Within a week, most patients feel completely back to normal.
What happens if an apicoectomy doesn’t work?
Apicoectomies have a high success rate, between 85% and 97%, when performed with modern techniques. However, if the procedure doesn’t resolve the infection, you still have options. The most common next step would be extraction of the tooth, followed by replacement with a dental implant or bridge. We will discuss all possible outcomes with you before surgery so there are no surprises.
Can I get an apicoectomy if I’ve had multiple root canals on the same tooth?
Yes, in fact, that’s often when an apicoectomy becomes the best option. If a tooth has had one or even two root canals and infection persists, the problem is likely at the very tip of the root, exactly what an apicoectomy is designed to fix. Rather than attempting a third traditional root canal (which has diminishing returns), we can perform a surgical procedure, remove the infected tip, and seal the root end directly.
Don’t Wait to Save Your Smile
If you’ve been told your root canal failed and the tooth needs to come out, get a second opinion from Dr. Lazer, Dr. Doroshenko, and Dr. Eghtesadi.
Call Cosmetic & Advanced Dentistry in Owings Mills at (410) 697-6290 or schedule your complimentary consultation online. Let us look at your tooth and see if an apicoectomy can help you keep it. We accept patients from Baltimore, Towson, Pikesville, and all surrounding areas.