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Dentistry/apicoectomy biopsy


After a root canal retreat,my endodontist recommended and performed an apicoectomy.  The indication for this procedure was a darkened area above the tooth (#4) on x-ray.  There was never any pain or discomfort.  He stated he found nothing unusual during the procedure but now wants to submit the samples for biopsy to Univ of Nebraska, the school he graduated from.  His office help said these samples always come back negative.  The cost of this is $160 and not covered by insurance.  I cannot afford the expense. When I explained this to him, he became angry stating I had agreed to this, which I never did, and stating he wishes he would have never taken this consult or done the surgery.  He finally stated that it was unethical of him to remove tissue  and not send it for pathology and that I was forcing him to pay for my biopsy out of his own pocket.  He insisted that I return to his office to sign the consent for biopsy and he would pay for it.
As I do not want him paying my bill I refused and he said he must do this for risk management.  I suggested he document in his notes that patient refused biopsy. This has has become crazy. Is a biopsy following apicoectomy this critical?  Thank you in advance for your response.

Tom - critical?  No it is not critical, since the chance of the biopsy specimen being a lesion that could spread or send fragments elsewhere in the body, like metastasis with cancer tumors, is very low, but if there is still growing bacteria in the area then it can grow and cause a future abscess or problem.  So the biopsy is a "belt and suspender" technique to make sure that the patient will not have problems in the future.

It is up to you to decide and if you don't want the biopsy, then that is your decision, but the doctor should have you sign a release in case a future problem develops that you accept it as your decision and refuse to blame the doctor.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


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.


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

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

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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