Endodontics · Apicoectomy · National Cost

How much does an apicoectomy cost?

Average Apicoectomy cost in the US: $870-$2,280

🏥 Based on ADA fee survey data
📊 Population-weighted national average
🔄 Updated May 2026
✓ Reviewed by Pearl clinical team
$870 – $2280

Typical Apicoectomy range across the United States

📍 All 50 states covered 🏥 PPO typically covers up to ortho max

National average

$1335

Apicoectomy · D3410, D3421, D3425, D3426

What is this procedure?

About this procedure

An apicoectomy (also called root-end surgery or surgical endodontics) removes the very tip of a tooth's root along with any inflamed or infected tissue around it. It is performed when a standard root canal — or a root canal retreatment — hasn't resolved an infection at the root tip, usually because of complex root anatomy, a blocked canal, or persistent bacteria the conventional approach can't reach. An endodontist makes a small incision in the gum, exposes the root tip, removes the affected tissue, and seals the end of the root with a biocompatible filling material.

The procedure is performed under local anesthesia, takes 30-90 minutes per tooth, and uses dissolving sutures that come out within 7-10 days. Apicoectomy is almost always the last option before extraction — it is considered when keeping the natural tooth is preferable to extraction plus an implant or bridge. Success rates run 75-90% at 5 years; failure typically means moving to extraction and implant. Cost is much higher than a routine root canal because of the surgical complexity, microscopy equipment, and specialist involvement.

Price factors

What affects this cost?

  • Tooth location: Anterior (front) apicoectomies are simpler than molars, where multiple roots and proximity to anatomical structures (sinus, mandibular nerve) increase complexity.
  • Number of roots: Molars typically have 3 roots; each additional root the endodontist must address adds to the cost.
  • Specialist vs. general dentist: Apicoectomies are almost always performed by endodontists with surgical microscopes — general dentists rarely offer this procedure. Specialist fees apply.
  • Imaging: Cone-beam CT (CBCT) is the standard pre-op imaging and is often billed separately.
  • Bone grafting: Some cases require simultaneous bone grafting around the surgical site, especially in larger lesions.
  • Geography: Specialist surgical procedures vary 40-80% by metro area.
  • Re-treatment scenarios: If a root canal retreatment was attempted first and failed, the apicoectomy may be quoted as part of a bundled treatment plan.

By state

Where does this cost the most and least?

Pearl tracks pricing across all 50 states. Below are the highest and lowest cost markets — click any state for a full state-level cost breakdown across covered cities.

Highest cost states

Lowest cost states

Quote checker

What should your quote include?

Different providers bundle costs differently. Here's what a complete quote typically covers — and what's often left out.

USUALLY INCLUDED IN THE QUOTED PRICE

  • Surgical microscope and ultrasonic root-end preparation
  • Local anesthesia and surgical setup
  • Small incision and flap reflection to expose the root tip
  • Removal of infected tissue and 2-3 mm of root tip
  • Root-end filling with biocompatible material (typically MTA or bioceramic)
  • Sutures and immediate post-op care
  • One follow-up visit to check healing

OFTEN BILLED SEPARATELY — ASK BEFORE YOU AGREE

  • Pre-op cone-beam CT scan ($250-$500 separately)
  • Re-treatment of the root canal if needed before surgery
  • Bone grafting if the lesion was large
  • Pain medication beyond standard prescriptions
  • Crown replacement if the existing crown is compromised during the procedure
  • Extraction + implant if the apicoectomy ultimately fails

Health stakes

What happens if you delay treatment?

  • Without treatment, the persistent infection can spread to adjacent teeth and surrounding bone
  • A chronic root-tip infection can cause facial swelling and abscess
  • Bone loss around the root tip continues, making future implant placement harder
  • Letting the tooth go to extraction means losing it and needing a $5,000+ implant
  • Untreated dental infection has been linked to systemic inflammation concerns

Before you agree

Questions to ask your provider

  • Has a root canal retreatment been considered before going to surgery?
  • What's the success rate you've seen for this tooth's specific situation?
  • Is the existing crown going to survive the procedure, or will it need replacement?
  • Will my insurance treat this as surgical endodontics or as a re-treatment?
  • What happens if the apicoectomy fails — extraction and implant?
  • Will I need bone grafting at the same time, and is it included?
  • Do you use a surgical microscope, and is that included?

Common questions

Frequently asked questions

A standard root canal cleans the canal from the top of the tooth down. An apicoectomy is performed from the side — the endodontist makes a small gum incision, exposes the root tip, and removes the infected tissue and tip of the root from the outside. It's used when the standard approach can't reach the infection because of root anatomy or a blocked canal.
Most PPO dental plans cover apicoectomy at 50-80% as a major surgical endodontic procedure, but pre-authorization is strongly recommended. Annual maximums ($1,000-$2,000 for most plans) are often exhausted by this single procedure. Some plans treat root-end surgery and conventional root canal retreatment as overlapping benefits — confirm before booking.
Most patients experience moderate swelling and tenderness for 5-7 days, managed with prescription pain medication and ice packs. Soft-food diet for the first week. Stitches dissolve in 7-10 days. Full bone healing around the root tip takes 6-12 months, monitored with follow-up x-rays.
Modern apicoectomies using surgical microscopes and bioceramic root-end fillings have 5-year success rates around 85-90%. Older techniques without microscopy had success rates closer to 60-70%. Failure typically means proceeding to extraction and implant placement.
Saving the natural tooth is usually preferred when possible — implants run $4,000-$6,000+ once you factor in extraction, bone graft, implant, and crown. An apicoectomy at $1,000-$2,000 with an 85% success rate is often the better economic choice. But if the tooth has structural problems, fracture, or significant bone loss, extraction and implant may be the right call.

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Compare what this costs in your city.

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