If a root canal procedure fails to stop the infection in the jaw, an apicoectomy may be the last measure to save the tooth. Occasionally, the abscess at the end of the root will not heal after the completion of the root canal therapy and the infection and inflammation will cause the tooth to be painful when biting. It is then necessary to remove the abscessed area by surgery.

To prevent the infection from progressing, and the resulting abscess from growing, a small incision is made through the gums into the jaw just above the affected tooth. A small portoion of the root end is removed as well as the associated infected tissue. Sometimes a filling will be placed in the root end to provide an additional seal. The area is then cleaned and flushed, and a suture placed to close the wound. With the infected area removed, and the incision closed, new bone will fill in the abscessed region.