Surgical approaches to the apical areas of teeth have been known since antiquity. The problem of inadequate root canal therapy led some dental surgeons to approach the diseased root apex from the apical and rather than by an approach via the root canal from the coronal end. It must be emphasized that the primary treatment of the nonvital tooth relies on conventional endodontic techniques only when this treatment has failed, or in a few elected cases, should endodontic surgery be considered. The design of flaps in endodontic surgery is of prime importance. As the surgical site is very limited and the mucosa on the alveolus is bound down, once the incision is made it is difficult to modify or change it. Careful thought should therefore be given to all factors that may have a bearing on the flap design. On the completion of surgery, patients should be informed of possible post operative sequelae and given full instructions regarding postoperative care.