Sometimes Endodontic treatment(root canal) fails to help the patient's immune system heal the pathology that causes their discomfort. Some of the possible reasons are large, long standing abscesses, abscesses that have been allowed to drain for extended periods of time, severely calcified canals, sere rely curved roots, complex anatomy of the canal system, & fractured instruments in canals.

Endodontic surgery or apical surgery(apicoectomy) is sometimes an option to extraction. It is important when considering apical surgery that every effort to clean and fill properly the canal system is exhausted. Endodontic surgery is usually performed by an Endodontist or an Oral Surgeon. These doctors have had specific advanced training in a dental school which offers these certified specialties. Endodontists have had two additional years of education beyond their dental school training specifically in root canal therapy. They are trained to treat difficult cases such as complex canal anatomy. This experience can be very valuable when endodontic surgery is considered. Apical surgery involves the dentist making a small incision over the gingival tissue that covers the area or infection. Once the tissue is reflected the infectious tissue surrounding the root which contains fluid and bacteria is gently curetted and cleansed. A filling may be placed over the root tip to help seal the canal. The incision is closed with resorbable sutures which are usually removed in 7-10 days.