Being told you need an apicoectomy or a bone graft before your implant carries a specific kind of anxiety. These terms sound serious. The procedures sound complicated. And most patients receive this news without a clear explanation of what is actually going to happen to them, or why.
NovoCare’s oral surgery team performs both procedures routinely at our Bole clinic. This article explains each one in plain language — what it is, why it is recommended, what the procedure involves, and what recovery looks like. Our goal is that you leave this page understanding your situation well enough to ask the right questions at your next consultation.
The Apicoectomy — Saving a Tooth After Root Canal
What an apicoectomy is
A root canal treatment cleans the infected tissue from inside a tooth’s root canals, fills the space with an inert material, and seals the tooth. For most patients, this resolves the infection permanently.
But in a small percentage of cases, infection persists — or returns — around the tip (the apex) of the root, below the gumline, even after a technically successful root canal. This happens because:
- The root canal system is anatomically complex. Some canals branch or curve in ways that make complete cleaning difficult even with specialist instruments.
- Bacteria can persist in the tissue immediately surrounding the root tip, outside the canal itself, in a way that conventional root canal treatment cannot address from inside the tooth.
- A cyst or granuloma (a mass of inflamed tissue) can develop around the root apex and fail to resolve after root canal treatment.
When retreating the root canal from inside the tooth is not feasible or has already been attempted without success, an apicoectomy is the surgical alternative.
What the procedure involves
An apicoectomy is performed under local anaesthetic as an outpatient procedure at NovoCare. The procedure is typically completed in 30–90 minutes depending on the tooth’s location and anatomy.
Your oral surgeon makes a small incision in the gum tissue near the affected tooth and gently moves the tissue aside to access the underlying bone. A small window is created in the bone to expose the root tip. The infected tissue and the last few millimetres of the root — including the tip where infection most commonly persists — are removed. The end of the root canal is then cleaned from this new access point and sealed with a small dental filling placed directly in the cut root surface.
The gum tissue is sutured closed. Bone fills in the small window naturally over the following weeks. The sutures are removed at a follow-up appointment approximately one week later.
What recovery involves
Most patients manage post-operative discomfort with standard over-the-counter pain relief for the first 48–72 hours. Swelling and mild bruising around the affected area are expected and normal. Soft foods for the first week. No smoking — this significantly impairs the healing of both the gum tissue and the bone.
The long-term outcome of an apicoectomy, when performed on an appropriate case with a well-planned approach, is very good. The procedure saves a tooth that would otherwise require extraction — and preserving a natural tooth, when feasible, is nearly always preferable to replacing it with an implant.
Bone Grafting — Rebuilding the Foundation Before an Implant
Why bone is lost after tooth loss
A dental implant requires sufficient bone to anchor it. The bone of the jaw — specifically the alveolar bone, the section that supports the tooth roots — is maintained by the stimulation provided by those roots. When a tooth is lost, the bone that once surrounded the root begins to resorb: it gradually reduces in both height and width, because the biological signal that maintained it is gone.
The rate of bone loss varies by patient, but it is progressive. After 12 months of a missing tooth, meaningful bone volume is typically lost. After several years, the bone may be insufficient in height or width to accommodate a standard-diameter implant.
For patients who are told they need a bone graft before implant placement, this is the clinical reason: there is not enough bone to place the implant in the optimal position with adequate primary stability and long-term support.
Types of bone graft
Socket preservation graft — performed at the time of tooth extraction, placing bone graft material into the socket immediately after removal to maintain bone volume during healing. This is the simplest and most effective way to preserve bone for future implant placement. If you know a tooth will need extraction and you are planning an implant, socket preservation should be discussed at the extraction appointment.
Lateral (horizontal) bone augmentation — used when the bone ridge is too narrow in width to accommodate an implant. Bone graft material is placed alongside the ridge and covered with a membrane that guides the bone to grow in the desired direction.
Vertical bone augmentation — used when the bone height is insufficient. More technically demanding and associated with a longer healing period than horizontal augmentation.
Sinus lift — specific to the upper back jaw, where the sinus cavity sits immediately above the available bone. A sinus lift creates space by lifting the sinus membrane and placing bone graft material beneath it, increasing the height of bone available for implant placement in this anatomically specific area.
Graft materials
Bone graft materials used at NovoCare include processed human donor bone (allograft), bovine-derived mineral (xenograft), synthetic hydroxyapatite (alloplast), and in specific cases, bone harvested from the patient’s own jaw or body (autograft). The choice of material depends on the graft type, the clinical situation, and patient preference.
All graft materials used at NovoCare are sourced from accredited suppliers and meet international biocompatibility standards.
The timeline: graft to implant
Bone graft healing takes time — the graft must be incorporated into the patient’s own bone before it can support an implant. The typical waiting period between a bone graft and implant placement is 4–6 months for most graft types. A sinus lift with significant bone augmentation may require 6–9 months.
For diaspora patients planning treatment around multiple visits, this timeline needs to be factored into the overall plan: graft on visit one, implant placement on visit two (6 months later), crown on visit three.
NovoCare provides apicoectomy and bone grafting procedures in Addis Ababa. Contact our team to discuss your specific case and timeline.