Apicoectomy

The teeth are held in place by strong roots that extend into the jawbone. The tip of each root, where the nerves and blood vessels enter the tooth to deliver blood to the crown (the visible part of the tooth), is called the apex. If a root canal does not successfully treat inflammation or infection caused by decay, an apicoectomy may be required. This procedure removes the apex of the tooth and seals it, preventing the damage from spreading to other teeth along with regression of the jawbone.

Reasons for an Apicoectomy
Like a root canal, the goal of an apicoectomy is to save the tooth and avoid the need for an extraction. There are a few reasons why it might be necessary.

Small adjoining root branches: Tooth roots can be extremely complex and contain many branches. If these branches cannot be properly cleaned and sealed during a root canal, inflammation can continue.
Blocked root canal: Besides of complex root branches, a root canal can be unsuccessful because it is blocked by a fractured file left behind from a previous root canal treatment. This can also cause infection and debris, which can affect adjacent teeth.
Narrow or curved root canals: If the root canal is poorly-shaped, the endodontic files cannot reach the root tip to clean it, making it more susceptible to infection.
Procedure
Before the surgery, an antibiotic or anti-inflammatory medication may be prescribed to treat the underlying infection. Panoramic x-rays will be used to plan the apicoectomy. Local anesthesia is administered before a small incision is made in the gum to expose the root. A tiny fraction of the jawbone may be removed to better expose the root, which will be removed, along with any infected connective tissue, using ultrasonic instruments. The root will then be sealed using filling material, and the gum will be sutured with stitches. Full aftercare instructions, as well as pain medication, will be provided, and the stitches will be removed after a few days. The connective tissues will take several months to fully heal.