What Is an Apicoectomy? Procedure and Costs Explained

Most people have heard of the dental procedure known as a root canal — seeing as more than 25 million of these procedures are performed every year.¹ However, there's a related, but slightly more invasive procedure you've probably only heard of if you need it. This is an apicoectomy, sometimes referred to as a “reverse root canal."

Apicoectomies are typically a "procedure of last resort" when other dental procedures — such as one or more root canals, or a dental bridge — fail to keep dental tissue healthy. An apicoectomy removes the tissue at the very tip of your root to allow the tissue to heal fully and the tooth to stay intact.²

What is an Apicoectomy?

An apicoectomy is a procedure designed to save a tooth when a traditional root canal cannot do so. Apicoectomies are performed by a specialized dentist known as an endodontist.³

During the procedure, a person's gum tissue is surgically opened around a tooth to access its supporting base. The endodontist then cuts away the tip of the root and any inflamed or infected tissue surrounding it.² In some cases, the endodontist may place a small filling there to seal the tip of the root canal and most likely will place sutures in the gingiva for proper tissue healing.

Root canal vs. apicoectomy

A root canal and an apicoectomy are similar in that both procedures often involve removing infected tissue in the root canals, known as pulp. However, an apicoectomy is more invasive and involves removing part of the root, and typically requires a strong local anesthesia, though it is still an outpatient procedure, like a root canal.⁴

Who Needs an Apicoectomy?

For some people, persistent inflammation, infection or crowding at the root's very base will require an apicoectomy. If your dentist recommends you need an apicoectomy, it's probably because a root canal was not effective at keeping your tooth or roots healthy, or you've experienced complications after a root canal, such as infection or inflammation.⁵

In some people, the roots of their teeth might not have enough room to grow freely and may be impinging on the root canals of adjacent teeth. In that case, an apicoectomy can prevent future problems in your teeth. An apicoectomy is usually a treatment of last resort aside from tooth extraction, which would then necessitate an implant, a bridge or some sort of denture, to keep the integrity of nearby teeth and your jaw.⁵

Read Related: How to Know if You Need a Root Canal

How Much Does an Apicoectomy Cost?

Without dental insurance, the average cost for an apicoectomy can range between $900 and $1,300.⁶ It may be even more, depending on certain factors, such as the location of the tooth and the qualifications of the dental professional.

With dental insurance, the average price for an apicoectomy ranges between $100 to $500, depending upon details of the insurance, such as whether deductibles have been met, and copays. If dental X-rays are not included in the price, these can run between $10 and $250.⁶

Ideally, the dental practitioner will be a member of at least one of the professional societies such as the American Association of Endodontists, the American Association of Oral and Maxillofacial Surgeons or the American Dental Association.⁶

Preparing for an Apicoectomy

Before the endodontist does anything surgical, you should expect the following:⁷

• You'll have a consultation with your endodontist about your medical history, medications, current condition and what to expect of the procedure.
• Dental X-rays will be made of the tooth in question and surrounding tissue and bone.
• You'll receive pre-procedure medication recommendations, which may include an antimicrobial mouth rinse, medications such as ibuprofen to reduce inflammation, and/or antibiotics.

How an Apicoectomy Procedure Works

Before the procedure begins, you will be given a local anesthetic, such as a shot to the gum, to numb the area. Once the area is numb, the endodontist will cut into your gum and move tissue aside to reach the root of your tooth. Typically, only a few millimeters of the root, including the root tip, will be taken out, as well as infected tissue around the root. They'll then likely seal your root tip, much like a regular tooth filling.⁵

Before you are stitched up, your endodontist may decide to take another X-ray to ensure there aren't any worrisome spaces around the tooth and in the jaw that could hold infection in the future. After that, the tissue is stitched up so the gum can heal and regrow into the space where the tissue was removed.⁵

Apicoectomy Recovery

An apicoectomy is slightly more invasive than a regular root canal, due to the need to cut into the gum tissue, so you will likely have some pain and discomfort afterward. However, you might also feel better, given that the source of much pain — the infection — has now been addressed.⁷

You're likely to experience some pain or discomfort following an apicoectomy, as you will have infected tissue removed and will have been injected with anesthetics, but it should resolve within a few days. And you should be able to resume regular activities within a few days. Most stitches used are dissolvable,⁸ though some endodontists use ones that have to be removed; these kinds of stitches will likely come out after a week.⁵

After apicoectomy surgery, there are some best practices that can help in the healing process, including:⁸

• Stay away from smoking, eating crunchy foods or doing anything that could damage stitches.
• Brush and floss gently.
• Take your medications as prescribed.
• If recommended by your dentist, take over-the-counter pain relievers or anti-inflammatories for pain or swelling.
• Use a cold compress or ice pack on the swollen areas (from the outside only).

• Eat only soft foods that are cool and easy to chew, such as yogurt, shakes, soft pasta, mashed potatoes and scrambled eggs. Do not sip through a straw.
• Rinse your mouth with warm salt water after every meal (don't spit, just let the liquid fall out of your mouth into the sink).
• Schedule and show up to all follow-up appointments.

Apicoectomy Risks and Complications

Even though this procedure is fairly common, no dental procedure is without risks. The following are some potential complications from apicoectomy surgery.

• The procedure could fail. If the procedure does not control infection, the tooth will have to be extracted and replaced with an implant.⁵
• Nerve damage. Because the roots of teeth at the back of the lower jaw are close to other major nerves, depending on the location of the affected tooth, nerves such as the mandibular nerve could potentially be damaged during the procedure. However, endodontists take steps to avoid such a complication.⁷
• The infection moves to the sinuses. If the affected tooth is in the upper jaw, it's possible for the infection to spread to the sinuses, though endodontists will typically prescribe antibiotics and other medications to treat any resulting sinus infections.⁸

Additionally, patients who are pregnant,⁹ lactating or have high blood pressure¹⁰ will need to consult with their doctors and endodontists to see if the procedure and medications used are safe.

If you experience bleeding or swelling beyond the suggested time frame, or excessive bleeding or pain, you may want to visit your dentist or doctor in case further complications, such as torn stitches or infection, has occurred.⁸

Financing an Apicoectomy Surgery With the CareCredit Credit Card

Whether you're getting an apicoectomy or you simply need a dental exam, the CareCredit credit card can help you pay for costs not covered by insurance.^* Apply today and use our Acceptance Locator to find a dentist or oral surgeon near you that accepts CareCredit. Use the CareCredit credit card, again and again, to pay for your health and wellness needs and download the CareCredit Mobile App to manage your account, find a provider on the go and easily access the Well U hub for more great articles, podcasts and videos.

Author Bio

Jordan Rosenfeld has been freelance writing for 21 years about finances, health, education and more. Her work has appeared in The Atlantic, The Billfold, Good Magazine, GoBanking Rates, Daily Worth, Quartz, Medical Economics, The New York Times, Paypal, The Washington Post and more.