Endodontic Surgery (Apicoectomy)

An apicoectomy, also called endodontic microsurgery or root-end surgery, is performed when infection or inflammation persists at the tip of a tooth's root after a previous root canal procedure. This can occur when bacteria remain in small accessory canals that cannot be reached through conventional retreatment, when a cyst or granuloma has formed at the root tip, or when the existing root canal filling is sealed beneath a well-fitting crown or post that would be difficult to remove without damaging the tooth. The procedure removes the infected root tip and surrounding diseased tissue, then seals the end of the root to prevent reinfection, allowing the natural tooth to remain in function.

At Tri-City Endodontics, apicoectomy is performed under a surgical operating microscope, which allows the canal anatomy at the root tip to be visualized at high magnification during cleaning and sealing. The procedure is performed under local anesthesia through a small opening in the gum tissue near the affected root. After the root tip is removed and the end of the canal is sealed with a biocompatible material, the gum tissue is repositioned and sutured. Most patients return to normal activity within a day or two, with sutures removed at a brief follow-up visit and complete healing of the underlying bone occurring over several months.

Dr. Malhan and the Tri-City Endodontics team have practiced in Pasco for more than 25 years and receive surgical referrals from general dentists throughout the Tri-Cities region, particularly for teeth where conventional retreatment is not the best option or has already been attempted. Each case is evaluated with three-dimensional imaging to assess the position of the root, the extent of infection, and the proximity of anatomical structures such as the sinus or nerve canals. Patients are informed of these findings and the realistic prognosis before surgery is scheduled, so the decision to proceed with apicoectomy, retreatment, or extraction is made with a clear understanding of the options