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Dentistry/Should I get a Root Canal or Apicoectomy?

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Question
Tooth #8
Tooth #8  

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I have had a root canal done & a had a pfm crown on tooth #8 back in 2007. Recently I went for a check up and they found a gum infection right over that tooth. The dentist sounded like she could not make up her mine on which one to go with. She said apicoectomy would be cheaper but root canal would probably be better but she said apicoectomy last time. So Idk which one to go with. I'm afraid i wont like my new crown if I go with root canal 7 will cost me more money. I'm also worried that the apicoectomy will leave a nasty scar and cause future discomfort.

Answer
Dear Nick,
Thank you for the question. As I state with every patient, without a clinical exam and a Cone Beam 3D Scan, it is difficult to precisely diagnose and treat your situation.
My tendency based on the many outcome studies, would suggest that non surgical retreatment of the root canal should be performed. This more conservative treatment usually has a higher sucess rate than surgery(Apicoectomy).
The main cause of a failing root canal is recurrence of bacterial infiltrate, previous inadequate debridement, lack of root canal filling seal and occlusal leakage. One or several of these factors may be contributing to your lack of healing and bone loss.
Treatment can be accomplished by using a diamond or gold cutting burr and making a small access opening in the back of your crown. This will provide access and visibility to retreat the root canal. After the root canal is retreated this access opening can easily be restored and your crown is not compromised. However, you should be aware that any time you proceed in this manner,the crown can fracture and need to be replaced. Also, once this acesss opening is made, the clinician may visualize crown margin leakage or decay that would nessitate a
new crown.

If after nonsurgical retreatment is performed,
in a small number of cases, healing does not occur, a surgical procedure (apicoectomy, periapical currettage and retro seal filling)can be performed.This gives you the option of following the best percentages in the science literature,for the best outcome. Further, it also would allow you a backup procedure to save the tooth.
My suggestion is to go to an Endodontist and get an opinion. Usually your general dentist can refer you.
If that is not possible,you can seek out care,at a dental school that would provide you with an Endodontist on the faculty.
Good luck and I hope everything works out for you.

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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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