Non‐surgical root canal therapy has proven to be a highly successful procedure when the case is properly diagnosed, treated, and restored. If non‐surgically treated tooth fails to demonstrate healing and the reason for failure is endodontic in origin and not periodontal, traumatic, or restorative in nature, apical surgery is often the treatment of choice. Significant advances in the use of magnification and illumination and supportive armamentarium in recent years have benefited treatment protocols in apical surgery such that teeth, which might otherwise have been extracted, now have a predictable chance for retention. The purpose of this article is to review the development and application of these advances and their implications in apical surgery.