Dentistry/Apicoectomy without root-end filling
Three months ago, I had a fistula with pus on the lip-side of the gum. An endodontist with the aid of a microscope did an RCT on Tooth no. 24.
The fistula with pus came back.
Two days ago, a different endodontist performed an apicoectomy on the same tooth. I never had this procedure before. The second endodontist did not use a microscope. He did not place a root-end filling. He said the gutta-percha was adequately sealing the tooth's canal so a root-end filling wasn't needed.
In apicoectomies, are the microscope and root-end filling sometimes optional?
This is a tough one to answer reasonably. In our office, the microscope and root-end filling are used almost all the time. It is rare that we wouldn't use one or both. However, that said, it is also a judgment call. The goal is to seal the end of the tooth and often that is done with the root canal filling alone. Lower front teeth have very small roots and it can be very difficult to place a well fitting filling. If the root was cut off at the correct bevel, visible inspection may have been enough to ensure the end was sealed. Microscopes help us see things we can't see with the naked eye. Once again, this could be a judgment call.
Obviously you are concerned about this. I would suggest that you call the 2nd endodontist and ask him/her these questions. They are reasonable and should have good answers. Perhaps the person who did this procedure should be the one to help here.
I know that doesn't give you a good, firm answer, but it's about the best I can do.
Gary Backlund DMD, MSD