Here’s roughly how an apicoectomy is performed:

Diagnosis & imaging

Dental X-rays or 3D scans (CBCT, etc.) to view root anatomy, bone structure, and locate the lesion.
Anesthesia

Local anesthesia is used to numb the region so you don’t feel pain during surgery.

Incision & flap

The gum tissue is incised (cut) and reflected (flapped back) to expose the underlying bone over the root tip.
Bone removal / osteotomy
A small amount of bone is removed to access the root apex and the infected tissue.
Removal of root tip & infected tissues
The tip (a few millimeters) of the root is cut away. Any infected or inflamed tissue around the apex is removed (curettage).
Sometimes bone grafts or membranes may be used if there’s a large defect.
Root-end preparation & filling
A small cavity is prepared at the root end (retrograde preparation). Then a filling (commonly Mineral Trioxide Aggregate (MTA) or biocompatible sealant materials) is placed to seal the root end.
Closure
The gum flap is repositioned and sutured (stitches).

Healing & follow-up

Over time, the bone regenerates around the root and the area heals. Periodic follow-up X-rays to monitor progress.
The entire procedure usually takes 30 to 90 minutes, depending on complexity and tooth location.

Benefits (Why Do It?)

Saves the natural tooth, avoiding extraction and replacement (implant, bridge, denture).
Removes lingering infection and inflammation that could damage surrounding bone or adjacent teeth.
Maintains jawbone integrity (bone loss is less likely when the tooth is preserved).
Often considered when retreating the root canal is not possible or carries high risk.
High success rates with modern microsurgical techniques. Some literature suggests 85% to 95% success in many cases.

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