What is an apicoectomy and how does it save a tooth?
An apicoectomy is a small operation on the tip (apex) of a tooth root. When a tooth has already had a root canal filling but an infection continues or returns at the end of the root, the dentist can go in from the gum side instead of through the crown: the gum is lifted, the infected tissue and the last two to three millimetres of root are removed, and the end of the root canal is cleaned and sealed with a filling material. The aim is to keep your own tooth in the jaw. Dental clinics in Turkey perform apicoectomy as a day-case under local anaesthetic. For the wider range of procedures see our dental treatments in Turkey.
This page explains when root-end surgery is advised, how it compares with retreatment and extraction, what it costs against the UK, US and Germany, what recovery feels like and how to check a clinic.
When is an apicoectomy needed?
The usual situation is a root-filled tooth that still has a dark area (a periapical lesion) on its X-ray, with tenderness on biting, a recurring gum boil or swelling. If the root canal can be redone from above, most dentists try that first. Apicoectomy is chosen when retreatment is not possible or has already failed: the canal is blocked by a post or crown that would be risky to remove, the canal is blocked or curved so that instruments cannot reach the end, a fine fracture or extra branch is suspected, or a previous retreatment has not healed the infection. Front teeth and premolars are the easiest to reach; lower molars and upper molars near the sinus are more difficult.
How is apicoectomy done, step by step?
The area is numbed with local anaesthetic, and you stay awake. The surgeon makes a small cut in the gum, lifts it, and creates a small window in the bone to reach the root tip. About three millimetres of root and the infected tissue around it are removed. Modern practice uses an operating microscope and fine ultrasonic tips to prepare the end of the canal and a biocompatible filling such as MTA or a bioceramic cement to seal it. The gum is stitched back, and an X-ray is taken to record the new root end. The operation typically lasts 30 to 90 minutes depending on the tooth, and stitches come out after about a week.
Does apicoectomy work? What the evidence says
Success depends heavily on the technique. Professional bodies such as the American Association of Endodontists describe microsurgery, with magnification and modern sealing materials, as giving clearly better outcomes than older methods using a drill and an amalgam filling. Healing of the bone around the root tip is judged by X-rays over six to twelve months, not by how the tooth feels in the first weeks. Not every tooth heals; a cracked root, a gum pocket that runs along the root or a poorly sealed crown can cause failure, and the surgeon should check for these before operating. A reasonable clinic will give you a likelihood in words and will not promise that the tooth will last for life.
Apicoectomy cost in Turkey compared with the UK, US and Germany
The ranges below are approximate per tooth and are not hospital quotes. The clinic confirms its price in writing after an examination and X-ray.
| Country | Approximate cost range |
|---|---|
| Turkey | €150 – €600 |
| United Kingdom | €450 – €1,500 |
| United States | €800 – €2,500 |
| Germany | €400 – €1,400 |
What changes the apicoectomy price: the tooth (a molar has several roots and takes longer than a front tooth), the use of a microscope and bioceramic filling, a 3D X-ray (CBCT) scan, bone grafting if the lesion is large, and whether the quote includes the X-rays, medication and follow-up check. Ask for a single written figure per tooth with these items listed.
Apicoectomy, root canal retreatment or extraction and implant?
| Option | Best suited to | Typical limits |
|---|---|---|
| Root canal retreatment | Canal that can be re-entered from above; first choice in most cases | Needs access through crown or post; may fail |
| Apicoectomy | Persistent infection when retreatment is not possible or has failed | Needs a restorable tooth and good bone support; surgery |
| Extraction and implant | Cracked, unrestorable or periodontally lost teeth | Tooth is lost; costs more over time; needs bone |
If the tooth cannot be saved, the next step is usually removal and replacement. In the upper back jaw, an implant may also call for a sinus lift, which is another reason to ask whether saving the natural tooth is realistic. The best choice depends on the tooth, the amount of bone and the crown above it, and the dentist should explain the reasoning.
Who is a good candidate, and when is surgery not advised?
Good candidates have a tooth that is restorable, has healthy bone support and gums, and an infection that has not healed after good root canal work. Surgery is less suitable for a root that is vertically cracked, a tooth with severe gum disease, an area very close to the nerve of the lower jaw or the floor of the sinus unless it is planned carefully with a 3D scan, and people with uncontrolled diabetes, poor healing or those on certain blood-thinning or bone-strengthening drugs without advice from their doctor. Smoking slows healing. The surgeon reviews your medical history before quoting.
Apicoectomy recovery: what to expect
For two to three days there is swelling and sometimes bruising of the cheek, controlled with cold compresses and simple painkillers. Soft food, gentle brushing away from the stitches and an antiseptic mouthwash keep the area clean. Most people return to work within one to three days. Stitches come out at about one week, the gum settles over two to three weeks, and the bone heals over several months. A follow-up X-ray at six to twelve months confirms that the area has healed. If pain increases after the first few days or a swelling returns, contact the clinic, as this can mean the infection has not cleared.
How many days do you need in Turkey?
Because the operation is a day-case, plan two to four days: a consultation with an X-ray or CBCT scan, the surgery, and a check the next day or the day after. Your home dentist can remove stitches if you fly home earlier; ask the clinic for a report and the X-rays. If you need other treatment at the same time, such as a crown after the root heals, the clinic should tell you how many visits it takes and whether the sequence needs a second trip. Oral surgeons who do this work often handle other jaw procedures, such as wisdom tooth removal, which can sometimes be planned in the same stay.
Risks and possible complications
As with any minor oral surgery, there can be swelling, bruising, bleeding, infection, temporary sensitivity and, in some cases, a recession of the gum margin around the tooth. Specific to the lower jaw is the risk of numbness or tingling if the nerve is close to the root tip, and in the upper jaw the sinus can be opened by accident, which usually heals but is monitored. The biggest practical risk is that the infection does not heal and the tooth must be removed later. The NHS advises seeing a dentist promptly for facial swelling, fever or difficulty swallowing, which can signal a spreading infection.
How to choose an endodontist or oral surgeon, and red flags
Look for an endodontist or oral and maxillofacial surgeon who performs root-end surgery regularly and uses a microscope. A trustworthy clinic takes a periapical X-ray or CBCT before quoting, explains why retreatment is or is not possible and gives a written plan with a price per tooth. Red flags: promising a 100 per cent success rate, a quote without images, no named dentist and no after-care plan. Read how our process works and send your X-rays through the free quote page. Surgeons who also perform bigger jaw operations, such as orthognathic surgery, have the training for bone work, but that does not replace asking how often they do root-end surgery.
- Why is apicoectomy chosen over retreatment for my tooth?
- Will you use a microscope and a bioceramic root-end filling?
- Do I need a CBCT scan, and is it included?
- What is the chance the tooth must be removed later, and what then?
- Who removes the stitches, and who checks the follow-up X-ray at home?
Hospitals with Dental Treatments in Turkey
Frequently asked questions
It is a small operation that removes the tip of an infected tooth root and seals the end of the canal through the gum. It is used to keep a root-filled tooth when the infection has not healed.
Often it does, particularly when a microscope and a modern sealing material are used and the tooth is otherwise sound. Healing is confirmed by X-ray after six to twelve months, and a cracked root can still cause failure.
Approximate ranges are €150 to €600 per tooth in Turkey, against around €450 to €1,500 in the UK. Molars cost more than front teeth, and a 3D scan or bone graft adds to the price.
The area is numbed, so the operation should not hurt. Soreness and swelling follow for two to three days and are usually controlled with simple painkillers and cold compresses.
Most people return to work within one to three days. Stitches come out after about a week, the gum settles in two to three weeks and the bone heals over several months.
Retreatment is usually tried first when the canal can be reached from above. An apicoectomy is chosen when retreatment is impossible or has failed, so neither is simply better.
Saving your own tooth is generally preferred if it is restorable and the bone is healthy. If the root is cracked or the tooth cannot be restored, extraction and an implant may be advised.
Two to four days is typical: consultation and X-rays, the operation and a check afterwards. Your own dentist can usually remove stitches after a week if you fly home earlier.
Swelling, bruising, bleeding, infection and temporary sensitivity are the usual effects. Rarer problems include nerve numbness in the lower jaw, sinus opening in the upper jaw and a lesion that does not heal.
Yes, in some cases, especially with a hidden root crack or a poorly sealed crown. A new swelling, pain or a gum boil after healing should be reviewed promptly, as retreatment or extraction may then be needed.