Apical Surgery in Wollongong

What is apical surgery?

Apical surgery — also known as apicoectomy, apicectomy, root end surgery, or periapical surgery — is a microsurgical procedure used to treat persistent infection at the tip (apex) of a tooth root when conventional root canal treatment or retreatment has not resolved the problem, or when retreatment is not feasible.

During the procedure, a small incision is made in the gum overlying the root tip. Approximately 3mm of the infected root tip is removed along with any surrounding infected tissue. The exposed root end is prepared with ultrasonic instruments and sealed with a bioceramic material — MTA (Mineral Trioxide Aggregate) or Biodentine — creating a watertight barrier that prevents bacteria from re-entering the bone. The gum is sutured closed and heals within one to two weeks.

Modern microsurgical apicoectomy performed by a specialist endodontist has a published success rate of 90–95% — a dramatic improvement over older surgical techniques that did not use microscopes or bioceramic materials.

Wollongong Endodontics is the only specialist endodontic clinic in the Illawarra region — meaning Illawarra patients who previously needed to travel to Sydney for specialist apical surgery can now have the procedure performed locally by Dr Deepak Chellappa and Dr Sara Namjou.

When is apical surgery recommended?

Apical surgery is not a first-line treatment — it is reserved for specific situations where conventional endodontic approaches cannot resolve the problem. Common indications at our Wollongong practice include:

• Persistent infection after root canal treatment or retreatment — ongoing symptoms or an enlarging radiolucency despite technically adequate endodontic treatment.
• Blocked or calcified canal preventing retreatment — the canal cannot be re-accessed from the crown due to calcification, ledging, or irreversible obstruction.
• Post or core that cannot be safely removed — retreatment would require removing a well-fitting post at risk of root fracture, or would destroy the existing crown.
• Fractured instrument at the apex — a separated file lodged at the root tip prevents adequate cleaning of the apical third.
• Biopsy of periapical tissue — persistent radiolucency requiring histological examination to rule out cystic or other pathology.
• Expensive crown or bridge that would be destroyed by retreatment — surgery preserves the existing restoration while addressing the infection from outside the tooth.
• Previous retreatment has already failed — surgery is the next step in the treatment hierarchy before extraction is considered.

Why the operating microscope is essential

Apical surgery is a precision microsurgical procedure that cannot be performed to the same standard without an operating microscope. At up to 25× magnification with coaxial illumination, the specialist can precisely identify the root tip anatomy, detect isthmuses (connections between canals), spot microfractures invisible to the naked eye, and place the root-end filling with sub-millimetre accuracy.

Every apicoectomy at Wollongong Endodontics is performed under the operating microscope by Dr Deepak Chellappa or Dr Sara Namjou. High-resolution photographs are captured during surgery and included in the electronic report sent to your referring dentist the same day — providing a clear visual record of the surgical findings and the quality of the root-end seal.

How CBCT guides our surgical planning

Before any apical surgery, we take a CBCT 3D scan to map the three-dimensional root anatomy, measure the proximity of critical structures (inferior alveolar nerve, mental foramen, maxillary sinus), assess bone thickness and fenestration, and confirm the extent and character of the periapical lesion.

Two-dimensional periapical radiographs cannot provide this level of detail — particularly for palatal roots of upper molars, lingual roots of lower molars, or teeth near the mental nerve. CBCT-guided planning reduces surgical risk, shortens procedure time, and improves outcomes. At Wollongong Endodontics it is standard for every surgical case.

The procedure — what to expect

Apical surgery is performed under local anaesthetic in our Wollongong rooms at G04/38 Atchison Street and typically takes 60–90 minutes:

1. Profound local anaesthesia — you will feel no pain throughout.
2. A small incision in the gum tissue exposes the bone overlying the root tip.
3. A small window is created in the bone to access the infected apex.
4. Approximately 3mm of the root tip is resected and the infected tissue removed.
5. The root end is inspected under the microscope, prepared ultrasonically, and sealed with bioceramic material (MTA or Biodentine).
6. The gum is repositioned and sutured. Sutures are removed after 5–7 days.

For anxious patients, oral or IV sedation is available. IV sedation is administered by a licensed anaesthetist and means you will have little to no memory of the procedure.

Recovery after apical surgery

Recovery is generally straightforward:

• Swelling — mild to moderate, peaking at 24–48 hours. Apply an ice pack (20 minutes on, 20 minutes off) for the first 24 hours.
• Pain — typically mild and well-managed with paracetamol and ibuprofen. Prescription pain relief is rarely required.
• Work — most patients return to desk work the next day. Avoid strenuous physical activity for 3–5 days.
• Diet — soft foods for 2–3 days; avoid chewing on the surgical site.
• Suture removal — return after 5–7 days for suture removal and wound check.
• Healing — soft tissue heals within two weeks. Bone regeneration takes 3–6 months and is confirmed on follow-up radiographs.

We provide detailed written post-operative instructions and are available by phone if any concerns arise during recovery.

Referring your patient for apical surgery in Wollongong

If your patient has persistent periapical pathology despite previous root canal treatment, or a case where retreatment is not feasible, refer for specialist assessment early. We will determine whether retreatment or surgery is the more appropriate path — and we will always discuss the recommendation with you before proceeding. If urgent, same-day assessment is available for patients in acute pain or with spreading infection.

Wollongong Endodontics serves patients from across the Illawarra, including Wollongong, Shellharbour, Dapto, Kiama, and Figtree. Referring dentists throughout the region can use our online referral form and attach the relevant radiographs and clinical notes. For pre-referral discussion, call (02) 4208 0155 and speak with one of our specialists directly.

Refer a Patient Online Why Refer to Us

Frequently Asked Questions