Is Root Canal Therapy Considered Oral Surgery? Apicoectomy Is an Endodontic Microsurgery

Patients often ask whether a root canal is "surgery" or "oral surgery." The confusion is understandable: root canal therapy removes diseased tissue, disinfects the inside of a tooth, and changes internal tooth structure. However, in most cases, root canal therapy is classified as a non-surgical endodontic procedure because it is performed through the tooth without making an incision into gum or bone. When infection persists after a well-done root canal or retreatment, a surgical form of endodontics called endodontic microsurgery (most commonly an apicoectomy, also called root end surgery) may be recommended to save the natural tooth. 

Start here: For the complete Apicoectomy Guide, see the Apicoectomy Endodontic Microsurgery Guide (Start Here).

What Is Root Canal Therapy?

Root canal therapy (endodontic therapy) treats infection or inflammation inside a tooth. The goal is to remove infected or damaged pulp tissue, disinfect the canal space, and then fill and seal the canals to reduce the risk of reinfection. Most root canals are performed under local anesthesia. After the tooth is sealed, a final restoration (often a crown) helps protect the tooth from fracture and leakage.

You may also see related search terms such as root canal surgery, tooth root surgery, or reverse root canal. These terms can be misleading, because a standard root canal is typically not categorized as surgery in the same way as procedures that require an incision into gum and bone.

Is a Root Canal Considered Surgery?

From a purely technical perspective, a root canal involves removal of tissue and internal reshaping of tooth structure, which can sound "surgical." In everyday dentistry and in most clinical classifications, however, root canal therapy is generally considered a non-surgical procedure because it is performed through an opening in the tooth and does not require cutting into the gum or bone. This is why many clinicians distinguish between:

• Non-surgical endodontics (root canal therapy, root canal retreatment)
• Surgical endodontics (endodontic surgery, apicoectomy, root end surgery)

Where the terminology often overlaps is when patients hear the phrase "root canal surgery". In practice, that phrase typically refers to endodontic surgery (most commonly an apicoectomy), not a conventional root canal performed through the crown of the tooth.

Apicoectomy Explained (Endodontic Surgery / Root End Surgery)

An apicoectomy is a targeted microsurgical procedure used to remove persistent infection or inflammation at the root tip (apex) after a tooth has already had root canal therapy (and sometimes retreatment). It addresses the problem from the "root end" side when the canal system cannot be predictably cleaned, accessed, or sealed from inside the tooth.

Root Canal vs. Apicoectomy: What Is the Difference?

When Is an Apicoectomy (Microsurgical Endodontics) Needed?

An endodontist may recommend endodontic microsurgery when a tooth is not healing after root canal therapy or root canal retreatment, or when anatomical factors limit predictable cleaning and sealing from within the tooth. While each case is unique, common scenarios include:

• Persistent infection or inflammation near the root tip after root canal treatment
• Hidden anatomy that is difficult to address from inside the tooth (for example, complex apical anatomy)
• Blocked access that limits full retreatment (for example, when internal removal of obstructions is not feasible or would carry unacceptable risk)
• Suspected root-end issues contributing to persistent symptoms (for example, apical leakage or root-end irregularities)
• Need to evaluate the root end directly to confirm the problem and manage it surgically

Importantly, a comprehensive evaluation (often including diagnostic imaging) is essential to determine whether the tooth is a good candidate for microsurgery or whether another approach is more appropriate.

Alternatives If a Tooth Is Not Healing

Treatment planning depends on the diagnosis, restorability of the tooth, periodontal condition, and patient goals. Alternatives may include:

• Root canal retreatment (a non-surgical attempt to re-clean and reseal the canal system)
• Extraction followed by replacement options (implant, bridge, or removable prosthesis)
• Monitoring in selected cases when symptoms are absent and risks are low (case-dependent)

Whenever possible, preserving a natural tooth can be advantageous for function and bite stability, but the right choice should be made after an informed discussion of risks, benefits, timelines, and total cost of care.

Frequently Asked Questions

Conclusion

A standard root canal is typically not considered oral surgery because it is performed through the tooth without incisions into gum or bone. When a tooth does not heal after root canal therapy or retreatment, a surgical option called surgical endodontics may be recommended. The most common procedure is an apicoectomy, which is often performed using endodontic microsurgery (microsurgical endodontics) to improve visibility and precision at the root end.

If you have been told you need a "root canal surgery," ask whether the plan is non-surgical retreatment or endodontic microsurgery, and make sure your case is evaluated with the appropriate diagnostics. The best treatment choice is always the one that matches the diagnosis and long-term restorability of the tooth.

Note: This page is for general education and does not replace a clinical examination, imaging, and diagnosis by a licensed dentist or endodontist.