Surgery is recommended when endodontic treatment was unsuccessful in treating the infection or the conventional treatment is ruled out by the medical condition of the patient. Endodontic surgery may also be considered as a diagnostic procedure to examine the entire structure of the tooth when the probable cause of infection cannot be delineated. There are different types of endodontic surgery. The endodontist will recommend the kind of procedure depending on your symptoms and the likelihood of success. An apicoectomy is performed if the infection keeps returning even after the root canal treatment or the infection is inaccessible to RCT. This procedure involves surgically removing the tip of the tooth's root, along with any infected tissue. The root tip is then sterilized and sealed. The tooth is anchored by a system of roots to the gums. Nerve and blood vessels that connect the tooth to the gums are enclosed within narrow canals interspersed in the root structure. Any infection of the canals leads to pain and discomfort. Bacterial infections can cause cavities and damage the roots. Treatment usually involves the elimination of infection and sterilization of roots with specialized instruments. In some instances, the infection returns after the root canal treatment. The dentist recommends repeating the RCT to treat the infection and to root out any portions of the tissue that might have been overlooked in the initial procedure. However, if the infection persists or a repeat RCT is not possible the dentist may opt for an apicoectomy.