Apicoectomy: When Your Tooth Needs Surgery to Clear a Persistent Infection
Apicoectomy Root-end Surgery is a specialized dental service provided by the board-certified specialists at Aloha Dental Specialty Center in Beaverton, OR. Microsurgical root-end resection — saving teeth that conventional retreatment cannot reach.
Apicoectomy: When Your Tooth Needs Surgery to Clear a Persistent Infection
An apicoectomy — also called root-end resection or endodontic microsurgery — is a surgical procedure where the endodontist accesses the root tip through the bone, removes the last 3 millimeters of the root apex along with any surrounding infected tissue, and seals the root end with a biocompatible material. It is indicated when a persistent periapical infection does not resolve after conventional root canal treatment or retreatment, or when retreatment through the crown is not feasible due to a well-fitting post or complex prosthetic restoration. At Aloha Dental Specialty Center, Dr. Ostovar performs apicoectomies using microsurgical techniques, the dental operating microscope, and MTA or bioceramic root-end filling materials.
Modern endodontic microsurgery bears little resemblance to the apicoectomies of decades past. Dr. Ostovar uses a microsurgical blade to make a precise mucoperiosteal flap, accesses the root apex through a small osteotomy using a piezoelectric ultrasonic unit (which cuts bone precisely without damaging soft tissue), resects the root tip at a near-perpendicular angle to minimize exposed dentinal tubules, prepares the root-end cavity with ultrasonic retro-tips under the microscope, and places MTA or bioceramic putty into the preparation. The flap is repositioned and sutured with microsurgical sutures. The entire procedure typically takes 45 to 75 minutes per root.
Recovery from microsurgical apicoectomy is faster and more comfortable than most patients expect. Swelling peaks at 48 hours and resolves over five to seven days. Prescription-strength ibuprofen and ice packs manage discomfort effectively. Sutures are removed at one week. We schedule follow-up radiographs at three months, six months, and one year to confirm bone regeneration at the surgical site. Contemporary microsurgical apicoectomy achieves success rates of 90 to 95 percent in published outcome studies — a dramatic improvement over the 50 to 60 percent success rates of traditional surgical approaches.
Serving Beaverton, Aloha, Hillsboro & Washington County
Aloha Dental Specialty Center is located at 18455 SW Alexander St, Suite A, in Beaverton, Or 97003egon. We serve patients from across the Tualatin Valley and greater Portland metro, including Aloha, Hillsboro, Tigard, Lake Oswego, and Tualatin. Our Beaverton office is a 5-minute drive from Aloha, 10 minutes from Hillsboro, and 15 minutes from Tigard via SW 185th Avenue.
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Intel Campuses (Ronler Acres & Jones Farm)
10 to 15 minutes via NW 185th Ave. We accommodate the schedules of tech professionals who need efficient, high-quality specialty care.
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Nike World Headquarters
About 8 minutes via SW Baseline Rd. We frequently see patients from the Nike campus for surgical and implant procedures with sedation options.
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Streets of Tanasbourne & Orenco Station
Easily accessible via US-26 and NW 185th. Local general dentists in these communities regularly refer patients to us for specialty procedures.
Why Local Dentists Refer to Us
We work as a trusted partner to general dentists throughout the Tualatin Valley. When cases require CBCT-guided planning, IV sedation, bone grafting, or other advanced procedures, local providers refer to Dr. Ostovar for his fellowship-trained expertise and predictable results.
We handle the complex surgical phases and coordinate closely with your general dentist for seamless continuity of care from start to finish.
Understanding Your Investment
At Aloha Dental Specialty Center, we provide transparent pricing before any treatment begins. The cost of your procedure depends on clinical complexity, materials used, and sedation requirements. We walk you through every line item during your consultation so there are no surprises.
What Affects Cost:
- Clinical Complexity: Bone loss, sinus proximity, nerve involvement, or the need for grafting affects treatment planning and surgical time.
- Materials: We use research-backed implant systems, purified bone graft matrices, and high-strength ceramics from established manufacturers.
- Sedation: Options range from local anesthesia to IV sedation, each with different associated costs. We discuss the best option for your comfort and procedure.
Insurance & Financing
We accept most major dental insurance plans and file claims on your behalf. Our team verifies your benefits before treatment and submits pre-treatment estimates with clinical documentation to maximize coverage.
For out-of-pocket costs, we partner with CareCredit and Cherry for flexible payment plans. We also offer our ADSC Dental Savings Plan for patients without insurance.
Recovery & Healing Timeline
Understanding the healing process helps you plan ahead and follow post-operative instructions for the best possible outcome.
First 48 Hours
Mild swelling and tenderness are normal. Apply ice packs in 20-minute intervals and take prescribed or over-the-counter anti-inflammatory medication. Eat soft foods and avoid the surgical site when chewing.
Days 3 to 7
Swelling peaks around day three and then improves. The tissue begins closing over the surgical site. Continue with soft foods and use any prescribed antimicrobial rinse. Most patients return to normal activities during this phase.
Long-Term Healing
Surface tissue heals within two to three weeks. Bone integration and deep healing continue for three to six months. Avoid smoking, follow up as scheduled, and maintain good oral hygiene throughout recovery.
Questions during recovery? Call us at (503) 822-0096. We are available for post-operative concerns.
Microsurgical Apicoectomy: Why Modern Technique Matters
The paradigm shift from traditional apicoectomy to endodontic microsurgery occurred with the adoption of the dental operating microscope, ultrasonic root-end preparation tips, and biocompatible root-end filling materials (MTA and bioceramics). Traditional apicoectomy used a large bevel angle (30 to 45 degrees), amalgam root-end fill, and no magnification — success rates averaged 50 to 60 percent. Modern microsurgical technique uses a near-zero-degree resection angle (reducing exposed tubules by 95 percent), ultrasonic retro-preparation that follows canal anatomy, MTA or bioceramic root-end fill that is biocompatible and promotes cementogenesis, and the microscope for visualization throughout. A 2020 meta-analysis in the Journal of Endodontics reported pooled success rates of 92 percent for microsurgical apicoectomy using MTA root-end fill — nearly doubling the success rate of traditional technique.
Why Choose a Specialist?
Dr. Merat Ostovar performs endodontic microsurgery using the dental operating microscope, piezoelectric osteotomy, ultrasonic retro-preparation, and MTA or bioceramic root-end filling materials — the full contemporary microsurgical protocol. His 15-plus years of endodontic experience include apicoectomies on anterior teeth, premolars, and accessible molars, with a focus on predictable outcomes and minimal surgical morbidity.
Your Apicoectomy Root-end Surgery Treatment Steps
- Consultation & Exam: Comprehensive apicoectomy root-end surgery evaluation with CBCT 3D imaging at our Beaverton office.
- Treatment Plan: Board-certified specialist discusses your apicoectomy root-end surgery options, timeline, and costs. Our procedures maintain a 95%+ success rate, backed by advanced 3D imaging and evidence-based protocols.
- Treatment: Procedure performed with comfort options including sedation if needed.
- Follow-Up: Post-treatment monitoring and care coordination for optimal healing.
Schedule Your Appointment Today
Book a consultation with our board-certified specialists at Aloha Dental Specialty Center in Beaverton, OR. Call (503) 822-0096 Office hours: Monday through Friday 7 AM to 7 PM, Saturday and Sunday 8 AM to 2 PM. or request an appointment online.
Related Services at Aloha Dental Specialty Center:
Dental Implants · Oral Surgery · Root Canal · Invisalign · Periodontics · Pediatric · TMJ Treatment · Sedation · Cosmetic · Emergency · Sleep Apnea
From Our Endodontic Team: Saving Your Natural Tooth
“I always tell patients: if we can save your natural tooth, that’s the best outcome. A well-done root canal with a good crown can last 15-20 years or more. The key is thoroughness — finding every canal, cleaning every curve, and sealing the system completely.
We use dental operating microscopes for every endodontic procedure. Under 20x magnification, I can see things that are invisible to the naked eye — hairline cracks, calcified canals, missed anatomy from a previous treatment. This is why retreatments done under a microscope have significantly higher success rates than those done without one.
The honest truth is that not every tooth can be saved. If there’s a vertical root fracture, or if bone loss around the root is too severe, extraction and implant may give you a better long-term result. I’ll always give you my honest assessment — I’d rather tell you the truth than do a procedure that’s likely to fail.”
— Endodontic Team, Aloha Dental Specialty Center, Beaverton, OR
I know many patients feel anxious about dental procedures — you’re not alone in that. What I hear most often after treatment is: “That was so much easier than I expected.” We’re here to make this as comfortable as possible for you.
Are You a Candidate for Apicoectomy Root-end Surgery?
Most patients in good general health are candidates for apicoectomy root-end surgery. However, certain factors may affect your eligibility or require modifications to the treatment plan:
- Medical conditions: Uncontrolled diabetes, autoimmune disorders, or blood-thinning medications may require coordination with your physician before treatment.
- Bone quality: For apicoectomy root-end surgery involving the jawbone, adequate bone density is essential. A CBCT 3D scan during your consultation determines this precisely.
- Smoking: Tobacco use significantly impairs healing. We strongly recommend quitting 2-4 weeks before and after any surgical procedure.
- Age: There is generally no upper age limit. What matters is your overall health, not your age. We have successfully treated patients in their 80s and 90s.
The only way to know for certain is a consultation with our board-certified specialists. Call (503) 822-0096 to schedule your evaluation — we’ll tell you honestly whether this is the right treatment for your situation.
Typical Healing Timeline:
Days 1-3: Initial healing, mild swelling managed with ice and medication. Days 4-7: Swelling subsides, gradual return to normal diet. Weeks 2-4: Soft tissue heals completely. Months 2-6: Bone remodeling and full integration (for surgical procedures). Individual recovery varies — we provide detailed post-op instructions specific to your procedure.
For additional clinical information, visit the American Dental Association (ADA).
Last reviewed by our dental specialists: March 2026. Clinical information on this page reflects current evidence-based dental practices.
Related Dental Services
Frequently Asked Questions
What is an apicoectomy?
An apicoectomy is a minor surgical procedure where the endodontist removes the infected tip of a tooth root and a small amount of surrounding bone, then seals the root end with a biocompatible material. It is performed when infection persists despite conventional root canal treatment and the tooth cannot be adequately retreated through the crown.
Is an apicoectomy painful?
The procedure is performed under local anesthesia, and IV sedation is available for anxious patients. Most patients report that the surgery itself is comfortable. Post-operative discomfort is managed with prescription-strength anti-inflammatory medication and ice packs, with swelling and tenderness peaking at day two and resolving over the following week.
How long does an apicoectomy procedure take?
A single-root apicoectomy typically takes 45 to 75 minutes. Multi-rooted teeth or cases requiring treatment of more than one root may take longer. The procedure includes flap reflection, osteotomy, root-tip resection, ultrasonic root-end preparation, placement of root-end filling material, and microsurgical closure.
What is the success rate of apicoectomy?
Modern microsurgical apicoectomy achieves success rates of 90 to 95 percent when performed with the operating microscope, ultrasonic instruments, and MTA or bioceramic root-end filling materials. This represents a dramatic improvement over traditional apicoectomy techniques, which had success rates of only 50 to 60 percent.
What is MTA and why is it used as a root-end filling?
MTA (mineral trioxide aggregate) is a biocompatible cement that sets in the presence of moisture, seals hermetically, has antibacterial properties, and promotes cementum regeneration on the root surface. These properties make it ideal for sealing the resected root end. Bioceramic putty — a newer generation of similar material — offers similar biology with improved handling.
How long is recovery after an apicoectomy?
Swelling peaks at 48 hours and resolves over five to seven days. Most patients take two to three days off from strenuous activity. Sutures are removed at one week. Diet should be soft for the first few days. Full bone healing at the surgical site takes three to twelve months, monitored with follow-up radiographs.
When is apicoectomy recommended instead of retreatment?
Apicoectomy is recommended when the original root canal filling appears adequate on imaging but infection persists, when a well-fitting post or complex prosthetic makes retreatment through the crown impractical, when a separated instrument blocks canal access, or when retreatment has already been attempted and failed. Dr. Ostovar evaluates each case individually.
Can an apicoectomy be done on a molar?
Apicoectomy on buccal (cheek-side) roots of upper and lower molars is feasible when there is adequate surgical access. Palatal roots of upper molars and the distal root of lower molars can be more difficult to access surgically. Dr. Ostovar evaluates CBCT imaging to determine whether surgical access is sufficient and whether the anatomy is favorable.
What happens if an apicoectomy fails?
If bone healing does not occur after apicoectomy, the options include re-surgery (if there is sufficient root length remaining), intentional replantation (removing the tooth, treating it outside the mouth, and reimplanting it), or extraction with implant replacement. Apicoectomy failure rates with modern microsurgical technique are less than 10 percent.
Will the apicoectomy affect the stability of my tooth?
Removing 3 millimeters of root tip does not significantly affect tooth stability or crown-to-root ratio in most cases. The tooth retains the vast majority of its root structure and periodontal attachment. Dr. Ostovar evaluates the overall root length and bone support before recommending surgery to ensure adequate stability will remain.
Is IV sedation available for apicoectomy?
Yes. IV sedation is an excellent option for patients who are anxious about surgical procedures. You will be relaxed and comfortable throughout the procedure while remaining able to respond to instructions. A responsible adult must drive you to and from the appointment.
How does the microscope improve apicoectomy outcomes?
The dental operating microscope provides 8 to 25 times magnification with coaxial illumination, allowing the endodontist to visualize the resected root surface, identify isthmus connections between canals, verify complete removal of root-end filling material from previous treatment, and place the new root-end filling with precision. Studies consistently show that microscope-assisted apicoectomy has significantly higher success rates than surgery performed without magnification.
Will I have visible scarring after an apicoectomy?
No. The incision is made inside the mouth along the gum line and heals without visible scarring. Microsurgical sutures are extremely fine (6-0 or 7-0) and produce minimal tissue reaction. The flap design is planned to avoid visible recession of the gum tissue, particularly important for front teeth in the esthetic zone.
Can I go back to work the day after apicoectomy?
Most patients take one to two days off from work, primarily due to facial swelling. The swelling is worse on day two before improving. If your work does not involve strenuous physical activity, returning on day two or three is typical. We provide a detailed post-operative instruction sheet and are available by phone if questions arise.
How much does an apicoectomy cost?
Apicoectomy fees vary based on the tooth location and the number of roots requiring surgery. Anterior teeth are less expensive than premolars or molars. Most dental insurance plans cover apicoectomy under surgical endodontic benefits. We verify your coverage and provide a cost estimate before scheduling the procedure.
Persistent Infection After Root Canal? Ask About Microsurgical Apicoectomy
Call our Beaverton office or request an appointment online. We look forward to helping you.
Clinically Reviewed by Dr. Merat Ostovar, DMD
Doctor of Dental Medicine | Implant & Specialty Dentistry | 15+ Years Experience
Aloha Dental Specialty Center — Serving Aloha, Beaverton, Hillsboro & Greater Portland
Last updated: March 19, 2026