Apicoectomy – Definition, Indications, Contraindications, Surgical Procedure, Complications


Definition: It is the cutting off, of the apical portion of the root and curettage of the periapical necrotic, granulomatous, inflammatory or cystic lesion.

Synonym: Apical Surgery, Root Resection, Endodontic Surgery, Root Amputation

Apicoectomy indications, contraindications and procedureIndications of Apicoectomy:

  1. Apical anamoly of root tip-dilacerations, intracanal calcifications
  2. Presence of lateral/accessory canal/apical region perforations
  3. Roots with broken instruments
  4. Root with overfilling
  5. Fracture of apical third of root
  6. Formation of periapical granuloma and cyst
  7. Draining Sinus tract
  8. Non responsive to RCT
  9. Over extension of root canal cement beyond the Apex
  10. Teeth with Ceramic Crowns
  11. When patient with chronic periapical infection
  12. Teeth with Apical resorption

Contraindications of Apicoectomy:

  1. Medically compromised patients
  2. Teeth with deep periodontal pocket and excessive mobility
  3. Teeth with poor Accessibility
  4. When there is extensive involvement of Bone
  5. Danger of involvement of anatomical structure

Steps of Apicoectomy:


  1. Preoperative Assessment
  2. Preoperative Consideration
  3. Preoperative preparation ( Intra oral and Extra oral)
  4. Armamentarium (Standard Surgical set)
  5. Anesthesia (LA, nasal intubation)

Step by Step Surgical Procedure of Apicoectomy:

  1. Design of Mucoperiosteal Flap
  2. Reflection of Mucoperiosteal Flap
  3. Exposure of Periapical Pathology and Root Tip
  4. Removal of Periapical pathology
  5. Ressection of Root Apex (Apical 1/3rd)
  6. Sealing of the Apex
  7. Toilet of the wound
  8. Smoothing of the Sharp Bony margins
  9. Bleeding Control
  10. Closure of the Surgical Wound – Suturing

Postoperative instructions, medication and care

Complications of Apicoectomy:

  1. Infection Flare up
  2. Cellulitis
  3. Ludwigs Angina
  4. Fracture of Maxilla and Mandible
  5. Soft tissue injury
  6. Opening of Maxillary Sinus – Oro Antral Fistula
  7. Secondary Hemorrhage
  8. Secondary hemorrhage
  9. Non vitality of Adjacent teeth
  10. Nerve Injury
  11. Luxation of adjacent teeth


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