Non-removable post
If a root post cannot be removed without destroying the tooth, the apicoectomy is the route via the root apex.
03 — Microsurgical procedure
Apico
ectomy in Kiel.
When conventional root canal treatment reaches its limits — the microsurgical procedure under the dental operating microscope. With CBCT planning and a bioceramic root-end filling over 90% success rate.
What is it?
Apical
microsurgery.
An apicoectomy (root-end surgery) is a microsurgical procedure in which the inflamed root apex and the surrounding inflammatory tissue are removed — through a small access via the gum.
It is used when the orthograde route (through the tooth from above) is not possible or has already been exhausted: with posts that cannot be removed, firmly lodged fractured instruments, secure restorations that are not to be destroyed, or large apical lesions.
Modern microsurgical apicoectomy under the operating microscope with an MTA root-end filling achieves success rates of over 90% — a major step forward compared with the classic “root-end amputation” of the 1990s.
When is it indicated?
When the
orthograde route is not enough.
We opt for an apicoectomy only once treatment “through the tooth” is not possible or not likely to succeed. Typical indications:
Fractured instrument
A fractured file fragment at the root apex that cannot be removed under the microscope can be resected together with the root apex.
Large apical cyst
If the inflammation at the root end has organised into a cyst and does not resolve from within the root canal — surgical removal.
Existing full crown
With an intact, high-quality restoration (e.g. a bridge abutment) that is not to be destroyed, the apicoectomy is often the gentlest route.
Persistent sinus tract
If a sinus tract persists after retreatment — a sign that the inflammation can only be reached surgically.
Diagnostic clarification
Some findings — root resorptions or cysts, for example — can only be diagnosed with certainty histologically, after removal.
Our approach
Next-generation
microsurgery.
Microsurgical apicoectomy differs fundamentally from the “classic” apicoectomy of the 1990s. Three innovations make the difference.
Dental operating microscope
What used to be done “blind” under a headlamp is today carried out at 25× magnification. The canal orifice at the resected root apex, isthmuses, the finest cracks — all of it visible.
Ultrasonic root-end preparation
Instead of coarse burs, microfine ultrasonically activated diamond tips are used — precise, gentle and true to the course of the root canal.
MTA / bioceramic root-end filling
Mineral trioxide aggregate or modern bioceramic materials seal the root from behind on a lasting basis and are biocompatible — bone can grow onto them.
3D planning with CBCT
Before every apicoectomy we plan with CBCT — we see exactly where the root apex lies and how close neighbouring structures are (nerve, maxillary sinus), and we can keep the access minimal.
How it works in practice
The procedure
step by step.
01
CBCT diagnostics & planning
Three-dimensional imaging to assess the root anatomy, the relationship to neighbouring structures and the size of the lesion.
02
Local anaesthesia
Complete, pain-free anaesthesia of the surgical area. For larger procedures, additional sedation is possible.
03
Microsurgical access
A small, precise incision in the mucosa directly over the root apex. We remove a tiny lamella of bone to create access.
04
Resection of the root apex
Under the microscope, the apical 3 mm of the root are removed — including any lateral canals and microcracks.
05
Removing granulation tissue
The inflamed soft tissue is removed completely — histologically often the confirmation of the diagnosis.
06
Ultrasonic root-end preparation
The root canal is prepared from behind to a depth of 3 mm with ultrasonically activated microtips — true to the course of the canal.
07
MTA root-end filling
Bioceramic sealing of the root apex. The material sets in a moist environment and remains tight and tissue-friendly in the long term.
08
Wound closure & healing
Fine sutures, often self-dissolving. Suture removal after 5–7 days. Bone healing becomes visible radiographically after 3–6 months.
90%+
Success rate
Microsurgical apicoectomy with an MTA root-end filling — compared with 60–70% for the classic technique.
3mm
Resection
Only the apical 3 millimetres are removed — where experience shows most lateral canals lie.
60min
Procedure time
The procedure typically takes 45–90 minutes — usually a single appointment.
Costs
What does
an apicoectomy cost?
The statutory health insurance covers the basic procedure (BEMA surgery). The additional microsurgical work, the microscope, MTA and bioceramic materials are a private-pay service.
Patients with private health insurance are generally reimbursed in full under the GOZ (German dental fee schedule).
Guide prices
- Apicoectomy, anterior tooth (1 root): approx. €500–800
- Apicoectomy, premolar (1–2 roots): approx. €700–1,000
- Apicoectomy, molar (several roots): approx. €900–1,400
- CBCT planning (often required): approx. €100–250
Before every treatment we provide a transparent cost estimate.
Frequently asked questions
Answers
about the procedure.
What patients ask most often before deciding on an apicoectomy.
When is an apicoectomy necessary?
An apicoectomy is indicated when apical inflammation persists despite root canal treatment (or retreatment) — and renewed orthograde access is not possible or not likely to succeed.
Typical reasons: posts that cannot be removed, firmly lodged fractured instruments, large apical cysts, an intact high-quality restoration (e.g. a bridge abutment) that is not to be destroyed.
Is an apicoectomy painful?
The procedure itself is pain-free under local anaesthesia. After the treatment, mild wound pain and swelling are normal — readily controlled with standard over-the-counter painkillers.
Most patients are fully back to their everyday routine after 2–3 days. Greater physical exertion should be avoided for a week.
How high is the success rate?
Apicoectomies carried out under the microscope with an MTA root-end filling achieve success rates of over 90%. Conventional apicoectomies without a microscope lie clearly below this (60–70%) — the operator factor is decisive.
Apicoectomy or retreatment — which comes first?
If both are possible: retreatment first. It is less invasive, sufficient in many cases, and can later be supplemented by an apicoectomy if needed. If retreatment is not technically feasible, the apicoectomy is the direct route.
How long does healing take?
Soft-tissue healing takes 5–10 days, after which the sutures are removed. The bony healing of the apical lesion becomes visible radiographically after 3–6 months and is complete after 12 months.
Can the tooth be crowned after an apicoectomy?
Yes — the apicoectomy affects only the root apex. The clinical crown is preserved. Existing restorations do not have to be removed. If a new restoration is planned, it is placed after healing.
What does an apicoectomy cost?
The cost is usually between 600 and 1,200 euros per tooth. Statutory health insurance covers a share of this. The additional microsurgical work and the bioceramic materials are a private-pay service. We provide a written cost estimate before treatment begins.
Do I need a referral?
No. You can book an appointment directly. If you have been referred by your family dentist, please bring recent radiographs or a CBCT scan if possible.
More treatments
Related
procedures.
An apicoectomy is often preceded by retreatment — afterwards the tooth needs a durable restoration.
Retreatment
Endodontic retreatment
First choice before surgical intervention.
Find out more DiagnosticsCBCT — 3D imaging
Mandatory before every apicoectomy — precise surgical planning.
Find out more RepairPerforation repair
Sealing injuries to the root wall with MTA.
Find out more SpecialRoot resorption
Treatment of internal and external resorptions.
Find out moreBook
Apicoectomy planned?
We advise you.
Diagnostics & surgical planning can be booked directly. Please bring recent radiographs.