This is a question I usually answer after telling a patient they need one, and I understand it sounds intimidating. I’m Dr. Emily Nguyen, Principal Dentist at Picasso Dental Clinic, and after performing these procedures for over 70,000 patients from 65 nationalities since 2013, I can explain exactly what an apicoectomy involves and why it’s sometimes necessary.
Why This Procedure Becomes Necessary
Root canals succeed about 85 to 95% of the time, but occasionally infections persist or return despite proper treatment. Sometimes the root canal anatomy is too complex, with tiny branches or curves that cleaning instruments cannot reach. Bacteria hide in these inaccessible areas and continue causing problems. What I’ve found treating patients across Vietnam is that some tooth roots simply have anatomy that makes complete cleaning impossible through the crown.
Cracks or fractures in the root tip can develop after initial root canal treatment, creating pathways for bacteria to reinfect the area. These microscopic cracks don’t show on X-rays until infection develops. By the time patients notice symptoms like pain or swelling, the infection has already established itself at the root tip.
Persistent infections sometimes result from curved or blocked canals that prevent instruments from reaching the very end of the root. Previous root canal filling material may obstruct the canal, making retreatment through the crown unsuccessful. In these cases, approaching the problem from the opposite direction through the gum and bone solves what cannot be fixed from above.
What Happens During the Procedure
The surgery begins with local anesthesia numbing the area completely. Patients remain awake and comfortable throughout. I make a small incision in the gum tissue near the problem tooth, typically just a few centimeters long. This provides access to the bone covering the root tip.
A small window opens in the bone to expose the root end. Using specialized instruments and often a surgical microscope, I remove the infected root tip, usually three to four millimeters. The infected tissue surrounding the root gets cleaned away completely. At Picasso Dental Clinic, we use high magnification to ensure thorough removal of all diseased material.
The root canal gets sealed from the bottom using biocompatible filling material. This reverse seal prevents bacteria from the mouth entering the tooth through the root tip. After confirming complete cleaning and proper sealing, I close the gum tissue with dissolvable sutures. The entire procedure typically takes 30 to 60 minutes depending on tooth location and complexity.
Recovery and What to Expect
Post-operative discomfort is usually moderate and well controlled with over the counter pain medication. Most patients describe it as less painful than the original root canal or tooth extraction. Swelling peaks around day two or three, then gradually subsides over the following week. Ice packs during the first 24 hours minimize swelling significantly.
I prescribe antibiotics to prevent infection and anti-inflammatory medication to reduce swelling. Soft foods for three to five days allow comfortable eating while the surgical site heals. Patients at our Hanoi, Da Nang, and Ho Chi Minh City locations typically return to normal activities within two to three days, though I recommend avoiding strenuous exercise for about a week.
Sutures dissolve on their own within seven to ten days. The bone regenerates over the following three to six months, completely filling in where the infected area was removed. Follow-up X-rays at three months and one year confirm proper healing and bone regeneration around the treated root.
Success Rates and Long Term Outcomes
Apicoectomy success rates range from 85 to 95% depending on tooth type and infection severity. Front teeth have the highest success rates because their roots are more accessible and typically have simpler anatomy. Back teeth, particularly molars with multiple roots, present more challenges but still succeed in most cases.
When successful, the tooth functions normally for many years, often for life. In my decade at Picasso Dental Clinic, I’ve followed apicoectomy patients long term and seen excellent outcomes. The tooth remains stable, comfortable, and fully functional. X-rays show complete bone healing with no signs of infection recurrence.
Failure usually becomes apparent within the first year through persistent or returning symptoms. If this happens, extraction becomes the recommended option. However, the apicoectomy attempt is worthwhile because it saves the tooth in the vast majority of cases without compromising the ability to extract later if needed.
Comparing to Alternative Treatments
The main alternative to apicoectomy is tooth extraction followed by replacement with an implant, bridge, or partial denture. Extraction solves the infection problem definitively but requires replacing the tooth, adding time, complexity, and cost. What I tell patients is that keeping your natural tooth when possible almost always represents the best option.
Root canal retreatment through the crown offers another alternative. The existing root canal filling gets removed and the canal cleaned and refilled. This works well when the canal system is accessible and no root fractures exist. However, if retreatment already failed once or the anatomy prevents adequate cleaning from above, apicoectomy becomes the better choice.
Some patients ask about just living with the infection or hoping it resolves on its own. This approach risks abscess formation, bone loss, infection spread to adjacent teeth, and even systemic health problems. Untreated dental infections don’t improve spontaneously. Addressing them promptly with appropriate treatment prevents more serious complications.
Who Needs This Procedure
Candidates for apicoectomy typically have teeth with persistent infections after root canal treatment, symptoms that return months or years after successful root canal, infections that don’t respond to root canal retreatment, or anatomy that prevents complete cleaning through the crown. X-rays showing bone loss at the root tip alongside symptoms like pain, swelling, or drainage indicate the need for evaluation.
Not every tooth is suitable for apicoectomy. Severely fractured roots, teeth with advanced bone loss, or roots too close to important structures like sinuses or nerves may require extraction instead. I evaluate each case individually at our clinics, considering tooth importance, overall health, healing potential, and patient preferences before recommending treatment.
Patients with certain medical conditions need careful evaluation before surgery. Uncontrolled diabetes, recent radiation therapy to the jaw, or medications affecting bone healing may influence timing or approach. Since 2013, I’ve adapted treatment plans for patients with various health conditions, ensuring safe and effective outcomes.
The Value of Saving Natural Teeth
People sometimes question whether saving a troubled tooth is worth the effort when implants exist as replacements. My answer after treating patients from around the world remains consistent: your natural tooth, even one requiring apicoectomy, functions better and lasts longer than any artificial replacement when the procedure succeeds.
Natural teeth maintain the bone better, provide superior sensation for biting, and require no special maintenance beyond normal hygiene. The investment in apicoectomy often costs less than extraction and implant placement while preserving your original tooth. This combination of functional, aesthetic, and financial benefits makes tooth preservation worthwhile whenever possible.
If you’re experiencing persistent pain or infection in a tooth that’s had root canal treatment, or if your dentist has recommended an apicoectomy, I encourage you to schedule a consultation at any of our Picasso Dental Clinic locations in Hanoi, Da Nang, Ho Chi Minh City, or Da Lat. We can evaluate your specific situation and discuss whether this procedure can save your tooth successfully.
