Dentistry/Complications following root canal
Seven months ago, I had an ancient filling in tooth #30 removed and replaced, due to decay. Prior to this, the tooth was symptom-free. After the new filling, I experienced pain while chewing (my only symptom). The dentist adjusted my bite several times over the course of 2-3 months but the pain persisted. The dentist mentioned he found a fracture in the tooth (while replacing a filling) and concluded I needed a root canal.
My dentist performed the root canal. While I was wearing the temporary crown, I had mild pain while chewing but the dentist was confident it was residual inflammation that would resolve. After the final crown was placed, the chewing pain continued. The dentist again adjusted my bite multiple times over the course of another 2 months, but the pain continued. X-rays showed a picture-perfect root canal.
Finally, the dentist referred me to an endodontist for evaluation. The endo said the original root canal had been performed very well, but recommended a re-treatment to see if he could determine anything otherwise. The endo performed percussion and temperature tests to confirm that the sensations were coming from tooth #30. Then he performed the re-treatment through the crown and filled the tooth with calcium hydroxide for two weeks. He did not find missed canals or signs of root fracture.
After two weeks, my pain was still present so the endo filled the tooth with a paste (eugenol?) to calm inflammation. After another week, my tooth was feeling better, but not pain-free. The endo decided to finish the root canal treatment and said we needed to wait to see if the tooth would eventually calm down. I asked about the possibility of a fracture, and he conceded that a hairline fracture is possible but he did not see any evidence of one (through his special microscope and multiple x-rays) and did not suspect one. He said the next step could be an apico but he does not want to do that because it's a major procedure and my bone in that area looks healthy.
It's been two weeks and I am returning to my general dentist to have the access spot in the crown replaced with a permanent filling (instead of the temporary filling there now).
So far, the pain remains. Any improvement made during the week that I had the steroid/anti-inflammatory paste inside the tooth has reverted. In fact, now I experience throbbing in the tooth when I exercise.
During the past seven months, I rarely have chewed on that side of my mouth so as to avoid pain and allow the area to rest. Only soft foods are tolerable on that side. I took antibiotics during the original root canal, though there has never been a sign of abscess or infection. After all procedures, I took large doses of ibuprofen, but otherwise no medication. I feel some soreness when flossing, and occasionally brushing; that sensitivity varies depending on the day, however.
I am not sure how to proceed. The ongoing pain and inability to chew on one side of my mouth is as distressing to me as the thousands of dollars I've spent on these procedures. At this point, I would prefer to have the tooth extracted than endure an apico because I don't want to spend any more money on a procedure that "might" work. I suspect the root is fractured, and I regret the retreatment, wishing I had put that money towards the extraction and an implant or bridge.
In your opinion, what are the chances that these symptoms are caused by irritation/inflammation, versus a possible fracture?
WOW.... sounds like you have been through it! You are an excellent historian and very through writer...thanks!
From what you have told me, it sounds like all your options, except the apico, have been explored. Obviously, something is not right. You have identified your remaining options....extraction or apico. In our office, when we have this situation, we really leave it up to the patient to make the final decision. There is no right answer here. I would also suspect the possibility of a more extensive fracture based on your dentist's original diagnosis of a fracture. However, roots of teeth can be convoluted and it could also be that, although the root canal looks great on the x-ray, something could still be wrong with it and might be able to be fixed with an apico.
With all that said and the uncertainty associated with an apico and your desire to put this all behind you, I would not talk you out of your decision for extraction. It is a sure thing that the pain will go away. Then an implant or bridge will get you fully functional again. In your situation, this sounds very reasonable.
Hope this helps with your decision.
Gary Backlund DMD, MSD