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• It is the surgical resection of the apex of the root.
• It is the procedure done in case of root canal treatment failure.
• If an infection does not subside even after root canal treatment,it may concern enquire a surgical procedure.
• In this procedure, the apical region of root is visualised by reflecting a flap and performing an osteotomy.

INDICATIONS :
• Aberrant Anatomy: Dilaceration of root apex do not allow endodontic restoration of apex.
• Obliteration of apex by secondary dentin.
• Iatrogenic repair: A broken endodontic file which cannot be retrieved by conventional means.
• Apex perforation.
• Improper apical seal which cannot be removed.
• Increased drainage of pus from root canal will not allow adequate apical seal.
• Open apex.
• Non healing periapical granuloma.
• Fracture of apical third of root.
• Periapical cyst/granuloma.

CONTRAINDICATIONS:

1. Local Contraindications:
   • Poor periodontal status of tooth.
   • Grossly decayed tooth.
   • Inadequate tooth length.
   • Acute infection.
   • Traumatic occlusion.
   • Uncooperative patients.
   • Close proximity of root apex to vital anatomic structures such as Maxillary antrum & Nasal floor.
2. Systemic Contraindications:
   • Poor medical status of diabetes,Bleeding disorders.etc
   

STEPS IN ENDODONTIC SURGERY:

1. Cleaning of the area involved with antiseptic solutions.
2. Local anaesthesia.
3. Design of mucoperiosteal flap & reflection of flap.
4. Bone removal for access to root tip.
5. Root tip resection & curettage.
6. Retro preparation & retrograde filling.
7. Suturing & Follow up.

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COMPLICATIONS:
• Mobility of tooth/adjacent tooth.
• Haemorrhage.
• Nasal perforation.
• Oroantral Fistula.
• Mental Nerve Damage.
• Inferior Alveolar Nerve damage.

REFERENCES:
• Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)
• DentaGama.com