Apicoectomy (root-end resection) is a microsurgical endodontic procedure that removes the apical 3 mm of the root, prepares a retrograde cavity into the canal, and seals it with a biocompatible material. It is indicated when orthograde retreatment is not feasible or has failed, or when symptomatic periapical pathology persists after conventional treatment.
- Persistent periapical disease after conventional root canal therapy or retreatment
- Procedural obstacles (post in place, ledges, separated instruments) preventing orthograde access
- Biopsy of periapical tissues
- Flap design: sulcular (Ochsenbein-Luebke in aesthetic zone), full mucoperiosteal, vertical releasing incisions as needed.
- Osteotomy: small diameter (3–4 mm), expose the apex identified by CBCT planning.
- Apical resection: remove 3 mm of root apex at a minimal (≤10°) bevel — the short bevel preserves palatal/lingual canal anatomy and reduces dentinal tubule exposure.
- Methylene blue staining under high magnification to identify the canal(s) and any isthmus.
- Retrograde preparation: ultrasonic retrotip (e.g., KiS, Spartan) cuts a 3 mm parallel preparation along the canal long axis.
- Retrograde filling: bioceramic putty (EndoSequence BC RRM, NeoMTA, BioDentine) or traditional MTA. Compact with micro-pluggers.
- Closure: 6-0 or 7-0 monofilament sutures; remove 3–5 days postop.
Modern microsurgical technique with bioceramic retro-fill materials yields success rates of 90–95% at one year (vs ~60% for pre-magnification-era technique). Key success factors: small osteotomy, ≤10° bevel, ultrasonic retro-prep, bioceramic fill, and magnification.