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Published September 2026

1 of 6A tooth that already had a root canal still has trouble at the very tip of its root
  1. A tooth that already had a root canal still has trouble at the very tip of its root
  2. Numbed. Nothing is done through the top of the tooth this time
  3. A small opening is made in the gum and bone beside the root tip
  4. The very tip of the root is removed
  5. The end is sealed from the outside and a stitch or two closes the gum
  6. Bone quietly fills back in over the following months

Who usually does it

endodontist. Referred to an endodontist or oral surgeon.

One question worth asking

Is this the step after a redo, or instead of one?

Root tip surgery, premolar, first root

Root canalsMajorD3421

D3421. Root tip removal on a premolar, first root.

When a root canal cannot fix a problem at the tip of a root, the surgeon opens the gum, removes the tip of the root and seals it from the outside. Related codes cover bone grafts during that surgery, removing one root of a molar, and replanting a tooth.

The gum beside the tooth is lifted, the last few millimeters of the root are removed along with the inflamed tissue around them, and the cut end is sealed from the outside before the gum is stitched back. Related codes cover adding bone graft during the same surgery, removing one root of a molar and keeping the rest, and putting a tooth back after it has been taken out. Most plans file this as Major. What they actually pay varies by plan.

Codes for this

D3410MajorRoot tip surgery, front toothRoot tip removal on a single-root front tooth; the simplest version.per tooth · Done sometimesD3421MajorRoot tip surgery, premolar, first rootRoot tip removal on a premolar, first root.per root · Done sometimesD3425MajorRoot tip surgery, molar, first rootRoot tip removal on a molar, first root.per root · Done sometimesD3426MajorRoot tip surgery, each extra rootEach additional root treated on the same tooth.per root · Done sometimesD3427MajorSurgery around the root without removing the tipCleans out the area around the root tip but leaves the tip in place.per tooth · Rarely doneD3428MajorBone graft with root tip surgery, one toothBone material added to the surgery site.per tooth · Rarely doneD3429MajorBone graft with root tip surgery, extra toothBone graft extended to a neighboring tooth in the same surgery.per tooth · Rarely doneD3430MajorRoot-end fillingThe small filling placed in the cut end of the root; billed with the surgery.per root · Done sometimesD3431MajorHealing protein with root tip surgeryA biologic gel added to help tissue heal.per site · Rarely doneD3432MajorHealing membrane with root tip surgeryA dissolving barrier placed over the surgery site.per site · Rarely doneD3450MajorRemoving one root of a molarCuts away one bad root and keeps the rest of the tooth.per root · Rarely doneD3460MajorImplant placed through the root canalA metal post is passed through the root into the bone to stabilize a loose tooth; very rare today.per tooth · Rarely doneD3470MajorRemoving and replanting a tooth on purposeThe tooth is taken out, treated outside the mouth, and put back in the socket.per tooth · Rarely doneD3920MajorSplitting a molar to remove halfThe tooth is cut in two and the bad half removed, leaving the good half as a smaller tooth.per tooth · Rarely done
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Part of these flowsRoot canal that did not settle

Related

Root tip surgery, premolar, first root (D3421): what happens, step by step | TruthMolar