After root canal treatment an apicoectomy is required when an infection develops or won't go away. Otherwise the tooth must be removed.Root canals can be very complex, with many tiny branches off the main canal. Sometimes, even after root canal treatment, infected tissue can remain in the branches or at the end of the root. This can possibly prevent healing or cause reinfection later.Often this will cause pain but in certain circumstances this can only be seen by x-ray. In this case immediate treatment is required, to prevent pain or even abscesses, or possible further bacterial infection of other organs.In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling using ultrasonic instrument, is then to seal the end of the root.

An apicoectomy is sometimes called endontic microsurgery because it is often done using an operative microscope or surgical eye.This method is the last chance of saving the tooth, but the success rate is very high. In the unlikely case of reinfection the tooth will have to be removed.This procedure is normally performed under local anaesthesia, or if requested under general anaesthesia.