An apicoectomy is a specialized surgical procedure performed by an endodontist, typically recommended when infection or inflammation persists at the tip of a tooth’s root following a conventional root canal treatment. The procedure involves surgically accessing the root tip, removing the apex and any surrounding infected tissue, and then sealing the end of the root canal to prevent reinfection. The actual time spent with the endodontist actively working on the tooth generally falls within a range of 30 to 90 minutes.
The Surgical Timeframe
The duration of the apicoectomy itself is usually between 30 and 90 minutes, depending heavily on the specific tooth being treated. Procedures on anterior teeth, such as incisors and canines, are generally the fastest because they typically have a single, straight, easily accessible root. These cases often take closer to the 30-to-45-minute mark.
The process begins with the creation of a small gum flap to expose the bone and the root end. After removing a small amount of bone to access the infected area, the endodontist removes the root apex and surrounding diseased tissue. The root canal is then cleaned and sealed with a biocompatible material, such as mineral trioxide aggregate (MTA). Procedures on molars are more complex due to multiple roots and limited visibility, pushing the surgical time toward the 60-to-90-minute range.
Variables That Affect Duration
Several biological and technical factors affect the duration of the surgery. The location of the tooth is a major determinant; molars have two or three separate roots with more complex anatomy than single-rooted front teeth, requiring more time to access and treat each apex individually. The physical structure of the root, such as severe curvature or calcification, can make the surgical resection and sealing process more challenging.
The extent of the infection or damage also impacts the duration, as larger areas of diseased tissue or bone may need careful removal. Proximity to delicate anatomical structures, like the maxillary sinus or major nerves, demands a slower, more cautious approach to avoid complications. Modern apicoectomies are often performed under a surgical operating microscope using specialized ultrasonic instruments to ensure a precise seal, which improves success rates but increases the overall time.
Total Time Spent in the Clinic
While the surgical procedure may take up to 90 minutes, the patient’s total time commitment typically ranges from 90 minutes to two hours. The appointment begins with administrative tasks and check-in. A substantial portion of this pre-operative time is dedicated to administering local anesthesia and allowing 10 to 15 minutes for the numbing agent to take full effect.
The endodontist spends time before and after the surgery reviewing the treatment plan, taking pre-operative images, and setting up the sterile field and specialized equipment. Following suturing, the patient receives detailed post-operative instructions, including medication guidance and care instructions for the incision site. This consultation ensures a smooth recovery before the patient is discharged.
Post-Procedure Healing and Follow-Up
In the immediate aftermath of the procedure, patients may experience swelling and discomfort, which typically peaks within the first 24 to 48 hours. Discomfort begins to subside noticeably after three to seven days. If non-dissolvable sutures were used, they are generally removed by the endodontist at a follow-up visit scheduled between three and seven days after the surgery.
The soft tissue of the gum heals relatively quickly, with the incision site often looking fully recovered within one to two weeks. However, the true measure of success involves the long-term healing of the bone around the root tip. Complete bone regeneration is a gradual process that can take several months, with full healing often observed at the six-month mark. To confirm the elimination of the infection, the endodontist schedules a final follow-up appointment, usually three to six months post-procedure, which includes taking an X-ray.