Apicoectomy or periapical surgery wherein an infection from the tooth localizes around the root of the tooth within the bone and forms a sac which may be an abscess, granuloma or a cyst. The infection may develop due to decay or sometimes trauma to the tooth. Periapical infection around the tooth apex due to trauma is very commonly seen with front teeth which are very susceptible to injury. This occurs due to long standing, unnoticed infection since it is generally painless.

Very often the trauma may have occurred many years prior to noticing the infection (as much as 10 or 20 years before!). It comes to light when an X-ray may be taken during routine checkups or for some other teeth.

Alternatively, since the tooth becomes non vital it starts getting discolored beginning with a yellowish hue and progressing to a grayish black discoloration which may be the only sign of tooth infection developing above the roots. This can be treated with root canal treatment along with a surgery around the tooth root apex.