Endodontic surgery may be necessary when nonsurgical endodontic treatment alone cannot save a tooth.  Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment.  However, in a few cases, a tooth may fail to heal and surgical removal of infected bone is needed; a tooth may have significant calcification within the canals and require surgery to clean and seal the remainder of the canals; surgery may be required to diagnose a fracture not visible on an x-ray; surgery may be needed to treat or remove damaged root surfaces or surrounding bone.

The surgical procedure most commonly performed is called an apicoectomy or root-end resection.  The endodontist opens the gum tissue near the tooth to see the underlying bone, remove or treat any infected areas and retrofil the apical portion of the tooth.  Silk sutures are placed and need to be removed about a week after the procedure.  The patient is awake for this procedure as local anesthetics are used.