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Dentistry/Apicoectomy whole root removal

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Question
Had a whole tooth root removed because oral surgeon said I had an infection. The root was in a crowned tooth connected to a fixed bridge.  procedure performed removed whole root and bone, it left an indentation in my gum and 3 months later I still feel aching in the area, how long does healing take. New x-rays by my family dentist shows no infection

Answer
Anthony,
Thanks you for your question. As I state,with all patient inquires, without a full clinical and radiological exam an exact diagnosis and treatment plan can not be formulated.
Your question leaves me somewhat puzzled on the exact status of the crowned tooth and a root that was removed. Yet you refer to an apicoectomy.
As a point of explanation, apicoectomy means minimally bevel the end of a root canal treated tooth to place a retro seal filling material into the exiting orifice of a root canal. This hermetic seal promotes bone and periodontal tissue healing  of the remaining root. Thus a root canal treatment needs to be performed through the tooth to eliminate the diseased and bacterial components in the root canal system. The canals have to be biomechanically instrumented and filled before an apicoectomy is performed.
On a rare occasion, a totally calcified root where a root canal can't be instrumented and filled with a tradional root canal filling,l may require an apicoectomy with a retrograde seal to promote healing.
A total removal of a root is called a root amputation. On an upper molar tooth that has a crown, root canal treatment must be performed on all the roots and sealed before a root is removed. This is essential because there is a blood and nerve supply that communicates and connects,all the root canals together. Thus it may be in your case that no root canal on the remaining roots and interconnecting blood and nerve supply has been treated with a root canal. If it is not treated the remaining roots will cause pain and infection. In your tooth a root was removed, was the connecting roots  treated with a root canal? In your case if there is still pain and lack of healing this could be the cause.
However, if your tooth has had a root canal and one of the roots was amputated due to decay or periodontal issues, then you may be in a position where the previous bone damage from the periodontal or inflamed bone due to an infected root canal may not be healing. It's also possible that your bone defect may heal with a greater amount of time. First scar tissue then bone fills in. This can take 6 months to 2 years. However, it's important that the cause of this pain and lack of healing be diagnosed.
Unfortunately with the history you have given me,pI can not narrow the issues.
My suggestion is to go an Endodontic specialist( root canal), possibly a periodontist( gum specialist) to evaluate your situation. If there is no one locally, I would suggest seeking out these specialist who teach in a dental school.T0his way you can get an accurate assessment of your particular situation.

I am sorry with your somewhat imprecise history I can't advise you in a more specific way. Good luck with your care.

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robert block

Expertise

I would prefer to answer questions related in my specialty of Endodontics( ROOT CANAL THERAPY) I am a Board Certified Endodontist with a special interest in advanced surgical endodontic procedures. I know root canals create a lot of apprehension in patients, and they usually have many questions about the procedure. I can address patient concerns either before or after their root canal treatment. I also have re-treated numerous patients who have had previous endodontic treatment. As a result of these clinical failures,and the increase in the use of dental implants, its important patients understand the alternatives of therapy. There are often many components to treatment that interrelate the disciplines of endodontics, periodontics and restorative dentistry.Patients frequently question the importance of considering all facets in a clinical regimen. Hopefully, I would be able to educate and contribute some information from the endodontic perspective.

Experience

Diplomate American Board of Endodontics, 35 years plus private practice experience. Formerly Professor and Chairman, Department of Endodontics at US dental school. Editorial journal reviewer for the endodontic section of The Journal of American Dental Association. Serve as a reviewer on several editorial boards.

Organizations
American Association of Endodontists, College of Diplomates, American Board of Endodontics

Publications
Over 150 publications, abstracts, case reports, chapters in textbooks. J. Dental Research, J. of Endodontics, J. of Oral Surgery Oral Medicine Oral Pathology,The NEXTDDS J.For example: The Single File Approach for Predictable Endodontic Canal Instrumentation:The Wave One, THE NEXTDDS J. 4-2:13-17 Fall 2014 Non Surgical Management of an Endodontic Failure Utilizing Contemporary Technology, www.THENEXTDDS 5-1:60-63 Spring 2015 Are You Still Using Formocresol? An Update, Tn. Dent. J. 89-4:14-19 Fall 2009 Management of Endodontic Failures, Oral Surg.vol.66:711-Dec.1988

Education/Credentials
BA. DePauw University, DDS. University of Michigan, MS. Medical College of Virginia, Virginia Commonwealth University, Gen. Practice Resident, University of Connecticut, Endodontic Resident Medical College of Virginia, Virginia Commonwealth University

Awards and Honors
Numerous Awards and Honors, Edward P. Hatton Award( Int. Assoc. of Dental Research), Endodontic Memorial Research Award ( American Association of Endodontics) Outstanding Endodontic Department Teaching Award (given by dental students)Fellow American Academy of Dental Science

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