An apicoectomy is a surgical procedure that attempts to remove infection, usually the result of a failed root canal surgery, from the tip of the tooth root (apex), the area where nerves and blood vessels enter the tooth and travel through a canal inside the root, and into the pulp chamber, which is inside the crown, or the part of the tooth visible in the mouth. During root-canal treatment, the canals are cleaned, and inflamed or infected nerve tissue is removed. Root-canal systems are very complicated with many small, off-shooting branches. Sometimes, even after root-canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later.

When a root canal fails it is usually due to an unusual and undetectable tooth anatomy, small accessory and lateral nerve canals that cannot be instrumented, cyst formation or a cracked tooth. Most of these failed root canals can be saved, with the exception of a severely cracked tooth.

The resulting infection of a failed root canal may be present in the absence of pain and X-ray evidence is usually required to diagnose the problem. An infection shows up on an x-ray as an unresolved black circle around the tooth. Sometimes a fistula, or pimple, might be present in the gum.

An apicoectomy, sometimes called endodontic microsurgery because the procedure is performed under an operating microscope, is usually performed only after a tooth has had at least one root-canal procedure and usually a second root-canal treatment.

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