Prevalence of apical periodontitis in previously treated teeth is reported to be as high as 50% in epidemiological studies. Although one cannot conclude that all these teeth need treatment, it is fair to assume that a large number of teeth with primary root canal treatment will require secondary treatment, surgical or non-surgical. The success of treatment of endodontic failures has been reported in the literature to be 70-80%. However effect of modern technique and technology on prognosis is yet to be known. The aim of this presentation is to evaluate indications for surgical and non-surgical approach. Treatment plan will be discussed and treatment option chosen based on quality of restoration and obturation of the previous treatment. A self-evaluation by the operator, of predictably improving disinfection, is the key to treatment planning. The procedure should be least invasive, time conscious and be chosen after a thorough risk assessment from tooth centered and patient centered perspective.