Expert: Gary Backlund, DMD, MSD - 12/27/2009

Question
Hello,
I had a root canal done on a top molar about a year ago. Then, in May, I developed a fistula. My dentist and endodontist, working together, recommended a procedure, which involved lifting up the gum, extracting some bone and replacing that with sealing material, which was described on the bill as a "guided tissue regen resorable." I was informed that the procedure might fail, but I don't believe I was told the failure rate.  Now, six months later, the tooth feels "wrong" -- there is some discomfort when I bite down, and the gum looks a little inflamed, although a fistula hasn't reappeared (yet). Today, I have been researching this problem online, and it looks like a apicoectomy was performed on me, is that correct? And I'm also wondering how likely it is that the infection came back after six months. And what might the signs of this be, besides a fistula? I need to be particularly careful about infection because of a history of endocarditis. Thank you!

Answer
Hi Ann,

I'm sorry to hear this is going on. Yes, it sounds like you had an apicoectomy. When we do this procedure, it is a last effort to save the tooth. The success rate is not as good as a regular root canal because it is designed to correct or repair a problem that was not resolved with the original root canal. There are some teeth that no matter what we do, don't ever heal. You may be facing that situation. A fistula is only an exterior drain of the abscess. While it certainly shows there is a problem, it alone is not an indictor of problems. When an apico fails, all the symptoms of an abscessed tooth are possible...pain, swelling, sore to bite, feelings of pressure, redness in the gums, etc. Your symptoms sound like the apico has failed. Obviously, I can't diagnosis your problem, but I would suggest you call your endodontist Monday and let the office know what you are feeling. I'm sure they will want to get you in for an examination and see what your options are.

Sorry for the bad news, but I hope it helps explain things.

Gary Backlund DMD, MSD