Most often, standard root canal treatment (and possibly retreatment) is sufficient to address dental problems associated with the root canal tissue and supporting periodontal (gum and bone) structures. Occasionally, an endodontic surgical procedure may be necessary to save a tooth from extraction.The name of the most common endodontic surgical procedure is Apicoectomy:(apico = apex or tip of the root, ectomy = to remove).

The success of standard root canal treatment and retreatment can be affected by variations in canal anatomy. These variations may include extra canals, excessively narrow (calcified) canals, and extreme curvatures of the canals. These variations can be impossible to manage with standard surgical intervention.

Additionally, the size of the localized endodontic infection, the species of bacteria comprising this dental infection, and the patient's inherent ability to heal properly after non-surgical root canal therapy have a large impact on the necessity of endodontic surgery.

Lastly, surgical exposure can aid in the diagnosis of a cracked root or in the locating of an accessory canal which may not appear on the radiograph and yet may be contributing to a patient's symptoms.