IMPLANT AND SURGERY
Apical Resection (Root-End Surgery)
A surgical option for root-end inflammation that cannot be resolved from within the canal
Provided at our clinic in Altunizade, Üsküdar (Istanbul).
IN SHORT
Apical resection is the surgical removal of the inflamed tissue at the tip of a tooth root, together with a small part of the root end, in a tooth that has not healed despite root canal treatment. The procedure is based on reaching the root end from the gum side, clearing the inflammation and sealing the root end. Apical resection is not the first option; root canal treatment or retreatment is considered first, and surgery is considered when those are unsuitable, in order to preserve the tooth.
What is apical resection?
Apical resection is a root-end operation in which ongoing inflammation at the tip of a tooth root is cleared surgically. In the procedure the root end is reached from the gum side, the inflamed tissue together with a small part of the root end is removed, and the root end is sealed with a suitable material.
The aim of this procedure is to preserve the problematic tooth rather than extract it. In other words, apical resection is an alternative to losing the tooth; it seeks to keep the tooth in the mouth in cases where treatment carried out from within the canal has not been enough.
The source of the inflammation at the root end is most often bacteria remaining within the canal system. Root canal treatment aims to clear these bacteria from within the canal. In some cases, however, the inflammation can only be cleared by reaching the root end surgically; apical resection is a method considered for exactly these situations.
When is it needed?
Apical resection comes onto the agenda in cases where the inflammation at the root end cannot be resolved by treatment carried out from within the canal.
The inflammation at the root end not healing despite root canal treatment or root canal retreatment.
Situations that prevent reaching the canal from the inside (for example, a sound crown or post over it).
The development of a cyst or a similar formation at the root end.
In most cases root canal retreatment is considered first; the details are covered on the root canal retreatment page. Apical resection is considered in cases where these options are unsuitable.
At the heart of this approach lies preserving the tooth as far as possible. If a tooth carries a sound crown or bridge, reaching the canal from the inside may require these to be removed, which means an additional procedure. In such cases reaching the root end surgically can be a way of saving the tooth while preserving the existing restoration.
In which cases is it unsuitable?
Apical resection is not a suitable solution for every tooth; it is preferred in cases where preserving the tooth is meaningful.
When making the decision, the benefit of preserving the tooth is weighed together with the extent of the procedure. For a tooth that has very little supporting tissue left and would be difficult to keep in the mouth in the long term, a surgical intervention often does not provide the expected benefit. This assessment is made separately for each tooth.
If the bone and supporting tissues surrounding the tooth are severely weakened, the tooth may not be preservable; in this case extraction may be a more suitable option.
Situations where the root end is very close to a nerve or the sinus cavity are assessed carefully in the procedure plan.
A bleeding disorder or certain systemic conditions require additional precautions before the procedure and should be reported to the dentist.
The procedure step by step
Assessment
The condition of the tooth and the root end is examined; in cases where it is deemed necessary, further imaging may be requested.
Anaesthesia
The procedure area is numbed with local anaesthesia.
Access
The gum is lifted to reach the area where the root end is located.
Clearing
The inflamed tissue and a small part of the root end are removed.
Sealing
The root end is sealed with a suitable material, and the gum is put back in place with sutures.
After the procedure and healing
In the first days after the procedure, swelling, mild pain and sometimes bruising may occur; these are expected and usually decrease within a few days. Applying cold helps to reduce swelling, and the sutures are removed at the time indicated by the dentist.
The regression of the inflammation at the root end and the healing of the bone in the area are processes that take time; for this reason healing is monitored over months with regular check-ups. Following the aftercare advice is important for the permanence of the result.
In the first days after the procedure there may be a slight sensitivity or a feeling of difference in the tooth; this usually decreases over time. Check-ups are of great importance in monitoring healing, because whether or not the inflammation at the root end has regressed can only be understood by assessment at certain intervals. For this reason the recommended check-ups should be attended even if no complaint remains. Check-ups make it possible both to confirm that healing is progressing correctly and, if necessary, to take an additional step in good time.
Risks and possible situations
Swelling, bruising and temporary discomfort may occur after the procedure.
Infection may develop in the area; following the aftercare advice is important.
In cases where the root end is close to a nerve or the sinus, the relevant structures are taken into account in the procedure plan.
Healing is not guaranteed in every case; if the inflammation does not resolve, other options — including extraction — may come up.
Comparison of root canal retreatment and apical resection
For a problem at the root end, retreatment carried out from within the canal and surgical apical resection are different paths. The table below compares the two.
Compare the options
| Root canal retreatment | Apical resection | |
|---|---|---|
| Approach | Into the canal from the inside (from the crown side) | To the root end from the gum side (surgical) |
| When | Usually the first choice | Cases where retreatment is unsuitable or not enough |
| Crown/post | May need to be removed | Can be done while preserving the existing crown |
| Aim | To preserve the tooth | To preserve the tooth (surgical option) |
Which option is suitable is decided together after an intraoral examination.
Frequently Asked Questions
The aim of apical resection is to preserve the tooth rather than extract it. However, if the supporting tissue of the tooth is severely weakened, extraction may be a more suitable option. Which path is suitable is determined by examination.
Healing is expected in most cases, but it cannot be guaranteed in every case. If the inflammation does not regress, other options are assessed. The result is monitored with regular check-ups.
In most cases, yes. If treatment that can be carried out from within the canal is possible, it is generally considered first; apical resection is considered in cases where this is unsuitable or has not been enough.
After the healing period, the tooth continues to carry out its function. In the first days it is important not to strain the area and to follow the dentist's advice; healing at the root end is completed over months and is monitored with check-ups.
Related treatments
The content on this site is for information only and does not replace a clinical examination. The suitability, duration and scope of treatment are determined after a clinical assessment.
This content was prepared by Dt. Mevlüt Yazıcı.
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Altes Diş Kliniği
Altunizade, Üsküdar, İstanbul
- PHONE+90 533 474 43 94
- EMAIL[email protected]
- ADDRESSAlperen İş Merkezi, Valide-i Atik Mahallesi, Altunizade, Nuhkuyusu Cd D:191/B, 34664 Üsküdar/İstanbul
- WORKING HOURSWeekdays 10:00–19:00 · Saturday 10:00–16:00 · Sunday closed