What is a microscopic apicoectomy?
A microscopic apicoectomy is a small operation in which an endodontist or oral surgeon removes the tip of a tooth root and the infected tissue around it, then seals the end of the root, all while looking through a surgical operating microscope. It is also called root-end surgery or endodontic microsurgery. It is used when a tooth has already had a root canal but an infection at the root tip persists or returns, and the dentist wants to save the tooth rather than extract it. This guide explains how the operation works, when it is advised, what the evidence says about success, what it costs in Turkey against the UK, US and Germany, what recovery is like and how to plan a short trip.
Why would a root canal tooth need root-end surgery?
A root canal removes infected tissue from inside the tooth and seals the canals. Sometimes bacteria remain in areas that instruments and disinfectant cannot reach, such as tiny side branches near the root tip, or a canal that is calcified or curved. The body responds with a dark area of inflammation on the X-ray, a cyst-like lesion or recurring swelling. If retreating the root canal from above is not possible or has already failed, for example because the tooth has a post and crown that you would rather not remove, the dentist can reach the problem from the side through the gum. Read our guide to root canal treatment for the first-line procedure.
How does the surgery work under the microscope?
The gum is numbed with local anaesthetic and a small flap is lifted to expose the bone. A tiny window is made in the bone over the root tip, and about three millimetres of the root end is removed together with the infected tissue. Under magnification the surgeon looks at the cut surface, finds the hidden canal branches and small cracks that were missed before, prepares the end of the canal with ultrasonic tips and seals it with a biocompatible material such as MTA or a bioceramic cement. The flap is then stitched back. The operation usually lasts 30 to 90 minutes, depending on the tooth: a front tooth is simpler than a lower molar.
Does a microscopic apicoectomy work?
For well-chosen teeth, yes. Systematic reviews have reported clearly higher success with modern microsurgery, using the microscope, ultrasonic tips and bioceramic fillings, than with older apicoectomy done without magnification. Success is judged by symptoms and by X-rays showing bone healing over 6 to 12 months. It is less predictable when the root is cracked, when there is advanced gum disease around the tooth, or when bone loss is extensive. A fair clinic will tell you the realistic chance for your tooth after reviewing a 3D scan, and will not guarantee it. The result also depends on the quality of the crown or filling that seals the top of the tooth.
How much does a microscopic apicoectomy cost in Turkey?
The figures are approximate ranges for one tooth, not hospital quotes. Molars are at the upper end of each range because they have more roots and are harder to reach.
| Country | Approximate cost per tooth |
|---|---|
| Turkey | €250 – €750 |
| United Kingdom | €700 – €1,900 |
| United States | €1,000 – €3,000 |
| Germany | €500 – €1,600 |
What changes the price: the tooth type and the number of roots, whether the operation is done by an endodontist with a microscope, the need for a 3D scan (CBCT), the root-end filling material, whether a bone graft is added and whether root canal retreatment or a new crown is also planned. Ask whether the scan, medication, stitch removal and a follow-up X-ray are included.
Apicoectomy, root canal retreatment or extraction: what are the alternatives?
The nearest alternatives are retreating the root canal through the crown, extracting the tooth and replacing it with an implant, or leaving the tooth under observation. Each has its place, and the dentist should explain why one is advised for your tooth.
| Option | Suits | Typical limits |
|---|---|---|
| Root canal retreatment | First choice when the crown and canals are accessible | May need removing a crown or post; some branches stay out of reach |
| Microscopic apicoectomy | Persistent infection after good root treatment; blocked canals | Needs enough bone and a restorable tooth; surgery |
| Extraction and implant | Cracked or hopeless tooth | Higher cost; months of healing; the tooth is lost |
If a tooth cannot be saved, our guide to endoscopic apicoectomy describes another surgical approach, and an implant may follow extraction.
Which teeth can be treated?
Front teeth and premolars are the most straightforward. Upper molar roots lie close to the maxillary sinus, so a sinus opening can occur and a scan is essential; for related procedures, see our note on sinus lifting. Lower molars sit near the nerve that supplies the lip and chin, which the surgeon must avoid. Wisdom teeth are usually extracted rather than treated; see wisdom tooth removal. A tooth with a vertical root fracture, little remaining structure or deep gum pockets is not a good candidate.
Recovery after a microscopic apicoectomy, day by day
Swelling and mild bruising of the cheek are normal and peak on the second or third day. Use a cold pack on and off for the first day, sleep with your head raised, take simple painkillers as advised and rinse gently with the antiseptic mouthwash the dentist prescribes. Avoid brushing the wound, spitting hard and chewing on that side for a few days. Stitches are usually removed after three to seven days. Most people return to work after one or two days. Bone heals over months; the dentist will want an X-ray after six to twelve months to confirm healing.
Your trip to Turkey: how many days
Plan four to six nights: a day for examination and a 3D scan, the operation, and a review after three to five days when the stitches can be removed or checked. Flying is usually allowed after the review, since the cheek swelling is mild and no gas or air is placed in the tissues. A follow-up X-ray is needed months later; ask the clinic to send you the images and report, so your own dentist can compare them. If a new crown is also planned, the timeline is longer.
Risks of root-end surgery
Common effects are swelling, bruising, tenderness and some gum recession. Less common are numbness or tingling if a nerve is near the root, a hole between the mouth and the sinus on an upper molar, infection of the wound and failure of healing, which may mean a second operation or extraction. The British Endodontic Society and the American Association of Endodontists describe root-end surgery as a recognised way to save teeth when conventional treatment fails, with the usual surgical risks. Smoking and poor oral hygiene reduce the chance of healing.
How to choose a clinic and red flags
Look for a dentist who has specific training in endodontics or oral surgery, uses a surgical microscope and a 3D scan, explains why retreatment is not possible and gives a written plan with the cost per tooth. Red flags include a quote without an examination or a scan, any promise that the tooth will "definitely" be saved, no microscope, rushed treatment of several teeth at once and no follow-up plan. Read how our process works and request a plan on our free quote page. All dental treatments in Turkey are listed in the hub.
Questions to ask the clinic before you book
- Is root canal retreatment possible first, and why is surgery needed instead?
- Will a surgical microscope and a 3D scan be used?
- Which material seals the root end?
- What is the realistic chance of healing for my tooth?
- Does the price include the scan, medication and stitch removal?
- Who reviews the X-ray after six to twelve months, and what if the tooth does not heal?
Hospitals with Dental Treatments in Turkey
Frequently asked questions
It is root-end surgery in which the tip of a tooth root and the infected tissue around it are removed and the end sealed, using a surgical operating microscope. It is used after a root canal that has not healed.
For suitable teeth it often does, and reviews report clearly higher success with microsurgery than with older methods. Healing is judged by symptoms and X-rays after six to twelve months, and no clinic can guarantee it.
As an approximate guide, about €250 to €750 per tooth in Turkey, against about €700 to €1,900 in the UK. Molars cost more, and the scan, medication and stitch removal may or may not be included.
The area is numbed, so the operation itself is not painful. Afterwards expect swelling, bruising and tenderness for a few days, which is usually controlled with simple painkillers and a cold pack.
Most people return to work after one or two days. Swelling peaks around day two or three, stitches come out after three to seven days, and bone heals over several months.
A root canal cleans and seals the canals from inside the crown of the tooth. An apicoectomy reaches the root tip through the gum and bone, and is used when infection persists after a root canal.
Retreating the root canal, extracting the tooth and replacing it with an implant, or monitoring the tooth. The dentist should explain why surgery is advised rather than one of these options.
Plan four to six nights: examination and scan, the operation, and a review after three to five days to check healing or remove stitches. A follow-up X-ray is needed months later.
It is a recognised procedure with the usual risks of minor surgery: swelling, bruising, rare numbness near a nerve, a sinus opening on upper molars, infection or failure to heal. A scan before surgery lowers these risks.
Yes, if the infection does not heal or the root is found to be cracked. Then a second procedure or extraction may follow. That is why the dentist checks the root and bone carefully beforehand.