Apicoectomy & Endodontic Microsurgery
Teaneck, NJ & Roselle, NJ
 If a previous root canal hasn’t fully healed and you’re still dealing with pain or pressure at the tooth, an apicoectomy at RJ Dental in Teaneck and Roselle, NJ can often save the tooth before extraction becomes the only option. Apicoectomy, sometimes called endodontic microsurgery or root-end surgery, is a small surgical procedure that addresses lingering infection at the very tip of a tooth’s root.
Most teeth that fail after a root canal can still be saved. The usual first option is nonsurgical root canal retreatment, where the original root canal is reopened, the canal system is cleaned a second time, and the tooth is resealed. When retreatment isn’t a good fit for your specific case, or has already been tried without lasting success, an apicoectomy is the next step before tooth extraction enters the conversation.
You’ve been through this once already, so straight answers matter. Our team uses cone beam CT imaging to see exactly what’s happening at the root tip before recommending anything, and we walk you through whether retreatment, an apicoectomy, or another option makes the most sense for your specific tooth. Most patients tell us they feel less anxious about the decision once they understand what each option involves and why.
On This Page
What Is an Apicoectomy?
 An apicoectomy is a microsurgical procedure that removes the very tip of a tooth’s root along with any infected tissue around it, then seals the end of the root with a small filling. The goal is to eliminate the source of stubborn infection that a standard root canal could not reach, while keeping the rest of the tooth in place.
A standard root canal cleans the inside of the canal from the top of the tooth down. An apicoectomy approaches the same problem from the other end. The surgeon opens a small window in the gum near the root tip, removes the infected tissue, and seals the bottom of the canal directly. The crown, the natural tooth structure, and any existing restoration usually stay untouched.
When an Apicoectomy Makes Sense
Apicoectomy is not a first-line treatment. We consider it when one of these patterns shows up:
- The original root canal didn’t fully resolve the infection and retreatment is unlikely to reach the source.
- The tooth has a complex root anatomy, an extra canal, or a curve that prevents thorough cleaning from above.
- A post or crown has been placed over the tooth and removing it for retreatment would risk fracturing the tooth.
- Retreatment has already been attempted and the infection persists.
- Imaging shows a cyst or granuloma at the root tip that won’t clear without surgical access.
If none of these apply, retreatment from above is usually the better starting point. The cone beam CT scan we take during your evaluation is what tells us which path is right for your specific tooth.
Endodontic Microsurgery vs. Older Surgical Techniques
Endodontic microsurgery describes the modern version of the procedure. We work through a smaller surgical window than older approaches, use magnification to see fine root anatomy that’s invisible to the naked eye, and use specialized instruments designed for working at the root tip. The result is a more predictable outcome, less tissue disruption, and faster healing than apicoectomies done in the 1990s. The procedure has changed significantly over the past two decades, which is part of why apicoectomy has a different reputation today than it did then.
Your Endodontic Surgery Provider in Teaneck and Roselle
Dr. Shahin Ghobadi is the oral surgeon at RJ Dental who performs endodontic microsurgery for our patients. He completed his postgraduate Oral Surgery residency at St. Joseph Regional Medical Center and is an active member of the American Association of Oral and Maxillofacial Surgery – full background on his bio page.
Apicoectomy sits at the intersection of endodontic work and oral surgery. The diagnostic side, reading the cone beam imaging that determines whether surgery is even the right call, matters as much as the surgical side. Dr. Ghobadi handles both, and that combination is part of why a previously failed root canal often has options at our practice that other offices would have to refer out to a specialist.
Your Apicoectomy Procedure, Step by Step
 An apicoectomy at our office typically takes 60 to 90 minutes from start to finish, depending on which tooth is involved. Front teeth go faster than molars because the root anatomy is simpler and the access angle is more direct.
Diagnostic Workup
Your first appointment is a consultation, not the surgery itself. We take a cone beam CT scan of the affected tooth and the surrounding bone to see the root tip in three dimensions. The imaging shows us the exact anatomy, the size and shape of any infection, and the position of nearby structures we’ll need to work around, including the sinus floor, the nerve canal, and adjacent roots. The scan determines whether apicoectomy is the right call, and if so, how we’ll approach the surgery.
Anesthesia and Comfort Preparation
Apicoectomy uses local anesthesia. We numb the area thoroughly before any work begins, and most patients describe the experience as similar to a dental filling once the anesthetic takes effect. You stay awake and aware throughout, but the area is fully numb. If you’re anxious about the procedure, tell us during the consultation; we’ll factor that into how we pace the visit.
The Surgical Procedure
Once you’re comfortable, we make a small access opening in the gum near the root tip. We then remove the infected tissue around the root, cut off the very last few millimeters of the root, and place a small biocompatible filling that seals the bottom of the canal. We use magnification throughout. We close the opening with a few sutures that typically come out about a week later, and the soft tissue heals over the underlying bone.
Recovery and Follow-Up
Most patients return to work the next day. Some swelling and tenderness are normal for the first 48 to 72 hours, which we manage with ice, over-the-counter anti-inflammatories, and a softer diet for a few days. Sutures come out at a brief follow-up about a week after surgery. The bone around the root tip then heals over the next several months, and we usually take a follow-up image at six months to confirm the area has filled in cleanly.
Benefits of Apicoectomy
The biggest benefit is straightforward: you keep your own tooth instead of losing it. Beyond that, the procedure offers some specific advantages over the alternatives.
You preserve the natural tooth root, which preserves the bone around it. When a tooth is extracted, the bone underneath begins to resorb within months, and rebuilding that bone for a future implant adds time, cost, and additional surgery to the equation. Apicoectomy avoids that whole sequence.
You typically keep any existing crown, post, or other restoration. Standard retreatment requires removing whatever is on top of the tooth to access the canal from above. Apicoectomy works from below, so the crown and post stay in place. That matters most for patients who already have significant restoration on the tooth and don’t want to redo all of it.
Recovery is short. Modern microsurgical techniques use a smaller access window than older surgical approaches, which translates to less tissue disruption, less swelling, and most patients back to normal within a few days. The procedure is also typically less complex than tooth extraction followed by a dental implant, because it’s a single procedure rather than a multi-stage workflow that can stretch across many months.
Why Choose Our Team for Endodontic Microsurgery
Most general dental practices don’t offer apicoectomy because the procedure sits at the surgical edge of endodontic work. At RJ Dental, having Dr. Ghobadi on staff as an AAOMS-member oral surgeon means a failed root canal doesn’t have to be referred out to another office. The diagnostic workup, the imaging, the surgery itself, and the follow-up all happen under one roof.
We use cone beam CT imaging on every case. CBCT changes what we can see at the root tip and which procedure makes sense, and we’d rather take the time to scan a tooth before committing to surgery than discover the wrong call after the fact. Our technology page covers the imaging tools we use across the practice.
We also tell patients honestly when apicoectomy isn’t the right call. Some teeth are better served by extraction and an implant. Some are better served by another retreatment attempt. Our job is to walk through the options on your specific tooth, not to push the procedure that happens to match the page you landed on.
We see patients from across Bergen and Union counties, including Hackensack, Englewood, Elizabeth, Union, and the surrounding towns near our Teaneck and Roselle offices. The dual-location setup means most patients can get to one of our offices without a long drive.
Apicoectomy Cost and Financing
Cost is a fair concern with any surgical procedure. The cost of apicoectomy depends on which tooth is involved (front teeth tend to be less complex than molars), whether retreatment was already attempted, and whether your case requires additional imaging or grafting. We give you a personalized estimate at the consultation once we’ve reviewed the cone beam scan.
Most dental insurance plans cover at least part of an apicoectomy because it’s an established treatment for failed endodontic therapy. We accept most major plans, including Delta Dental, Aetna, Cigna, MetLife, Guardian, Horizon Blue Cross Blue Shield, United Concordia, and UnitedHealthcare. Our front office team verifies your benefits before treatment so you know what to expect. Our financial information page lists every plan we accept.
For the portion not covered by insurance, we offer flexible payment plans, and we work with CareCredit, Sunbit, and LendingPoint for longer-term financing options. Cost shouldn’t be the reason you lose a tooth that could otherwise be saved.
Schedule Your Apicoectomy Consultation
A failed root canal doesn’t have to mean losing the tooth. The first step is a consultation and cone beam scan to determine whether apicoectomy, retreatment, or another option fits your case. Call our Teaneck office at (551) 369-2001, our Roselle office at (908) 488-5005, or book through our Request an Appointment page. We’re at 865 Teaneck Rd in Teaneck, NJ 07666. Our Roselle office is at 121-125 Chestnut St, Suite 201 in Roselle, NJ 07203.
Frequently Asked Questions
Will an apicoectomy hurt?
Apicoectomy uses local anesthesia, so the area is fully numb during the surgery. Most patients compare the experience to having a dental filling once they’re numb. Afterward, mild soreness and swelling are typical for two to three days, manageable with ice and over-the-counter ibuprofen. Patients are usually surprised at how mild the recovery is.
How long does it take to recover from an apicoectomy?
Soft tissue healing wraps up at the one-week mark, when sutures come out. Active swelling typically peaks around 48 hours and is mostly gone by day five. Most people are back to normal activity within 72 hours, though we recommend skipping the gym for about a week. Bone healing under the surface continues for about four to six months, and we confirm clean healing at a six-month follow-up image.
What happens if my apicoectomy doesn’t work?
In the small percentage of cases where the infection returns or doesn’t fully resolve, the next step is usually extraction of the tooth, often followed by a single-tooth dental implant to fill the gap. We monitor every apicoectomy with follow-up imaging precisely so we catch any issue early. If the procedure isn’t going to hold, you’ll know within the first six to twelve months, not years later.
How successful is an apicoectomy?
Modern endodontic microsurgery has significantly higher success rates than older surgical approaches because of better imaging, magnification, and sealing materials. The success rate for any individual case depends on the specific anatomy, the cause of the original failure, and your healing response. We don’t quote generic statistics because they vary widely; the consultation gives you a more accurate picture of what to expect for your specific tooth.
Will my dental insurance cover an apicoectomy in Teaneck or Roselle?
Most dental plans cover apicoectomy as an established endodontic procedure. Coverage percentages vary by plan and by whether you’ve used your annual maximum on other treatment. Our front office team at RJ Dental verifies your specific benefits before any procedure begins so you have a clear breakdown of what insurance covers and what your out-of-pocket portion will be.
Should I have an apicoectomy or just extract the tooth?
Apicoectomy preserves the natural tooth and any restoration already on top of it; extraction means starting over with a multi-stage replacement. If the tooth has a healthy crown, post, or significant restoration, apicoectomy is usually the better call because it avoids the implant pathway entirely. If the tooth is heavily damaged, fractured, or already structurally compromised above the gumline, extraction followed by an implant is often the better long-term option. We use the cone beam scan and an in-person exam to make that recommendation.
Can I drive myself home after an apicoectomy?
Yes. Apicoectomy uses local anesthesia only, so you’re not sedated and you don’t need a driver. You can drive yourself to the appointment and home afterward. Some patients prefer to bring someone along for company, but it’s not a clinical requirement.
How is an apicoectomy different from a root canal retreatment?
Retreatment reopens the tooth from the top, removes the original filling material, cleans the canal again, and reseals it. Apicoectomy works from the bottom, removes the very tip of the root along with the infected tissue, and seals the root end. Retreatment is the usual first option when a root canal fails. We reserve apicoectomy for cases where retreatment isn’t viable or has already been attempted without success. |
