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Dentistry/dental phobic:retreatment of root canal/apicoectomy

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Question
The seal around the root of an old root canal has broken and there is an area of granulation tissue and bone resorption. I have seen a periodontist who says that the tooth ,a lower second molar needs a molar retreatment/apicoectomy/retrograde filling/bone replacement graft/. I am completely dental phobic and cannot afford the $2,000 IV sedation the periodontist offers, but am terrified that the triazolam offered instead as part of the procedure cost will leave me awake, aware and in pain as well as total panic. I have read that triazolam can provide some amnesia in some patients, but I am totally panicked that I will be one of the patients who feels the pain and is aware and there is nothing I can do at that point.  I usually require more anesthesia/numbing medication for fillings etc, than normal patients (red hair) I also tend to bleed more than the average patient (so I've been told). What are my options? Would an implant be more successful/less painful in the long run? Or would the extraction and waiting for implant and insertion be more painful overall with a less successful outcome? Tried asking at periodontists for reassurance on pain levels, got blown out of the water, basically told take it or leave it. Any advice would be gratefully accepted.

Answer
Teresa -  Run from the periodontist!!!   This is not procedure that they are trained in and only attempt it as a way to make additional money.  A bone graft, especially if there is an area of inflamed granulation tissue is a situation potentially leading to disaster.  The graft would become a source of growth of any bacteria in the area, which could feed on the graft and the associated blood in the area.  

There are only two types of dentists who should attempt this procedure.  An endodontist, a root canal specialist, is often faced with failed root canal treatments and they are trained in doing apicoectomies.  The only problem here is that that location of the tooth is sitting just above the mandibular nerve (the same nerve that is given novocaine and numbs the lip and chin).  This proximity to the nerve often causes endodontists to not attempt apicoectomies on these teeth and refer them to an oral and maxillofacial surgeon.  That is the type of doctor you should see.  A board certified oral and maxillofacial surgeon.  Not only are they skilled in the surgery, but these doctors are skilled in the use of anesthesia in their office to render their patients asleep and not just lightly sedated as triazolam would do.  

So my suggestion is to have a board certified oral and maxillofacial surgeon near you examine you and do the surgery if necessary.  If you wish, you can get back to me, tell me where you live and I can give you names of doctors near you who are board certified surgeons.

If you have other questions, feel free to contact me also.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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