Expert: Mark Bornfeld DDS - 6/22/2007

Question
Hi There,
I had a root canal performed approx. 10 years ago on one of my front tooth (#7).  My last x-ray revealed that I  have an infection on the tip of the root and has abscessed. I got two recommendations. One endodontist recommended a root canal retreatment as he believes that would be the least intrusive of all options, however, another endodontist recommended apicoectomy to protect the existing crown.  How should I weight the costs/benefits of both options?

Thanks,
Winnie

Answer
Dear Winnie,

It's difficult to compare the two procedures' costs in a meaningful way without having some idea of the respective procedures' predicted prognosis. In my experience, apicoectomies tend to have a somewhat lower probability of successful outcome than root canal re-treatments, but this may have more to do with the fact that apicoectomies are usually selected as a last-ditch effort to salvage teeth in trouble rather than an indication of the procedures' relative merits.

To justify a root canal re-treatment, your endodontist should be able to identify what went wrong with the first root canal and be confident he can overcome that obstacle. For example, if a canal was overlooked in the first root canal or if a root canal filling is incomplete and these procedural errors can be corrected, it makes sense to try another root canal. On the other hand, if the initial root canal treatment looks like it has been well-executed, simply re-doing the job and expecting it to succeed is an act of hubris rather than pragmatism or logic.

The associated costs should be considered, though. If you have a post cemented in the canal of the tooth, it will likely be necessary to re-make the post and crown if it is decided to do a root canal re-treatment. However, if the tooth only has a crown on it and does not have a post, it may be possible to access the root canal through a small hole drilled in the back of the crown, which can later be filled. In this way, it isn't necessary to incur the cost of making a new crown even if root canal re-treatment is selected.

Another consideration is the length of the root of the tooth. Upper lateral incisors typically have rather short roots, and apicoectomy effectively reduces the length of the root even more. The surgeon must realistically assess whether the tooth will retain sufficient bone support after the procedure in order to justify it.

To sum up, your endodontists must give an honest appraisal of what the likely outcome of their treatments will be, including associated costs. In the final analysis, though, there will always be some uncertainty which course of action is the right one. At some point you must go with your gut and hope for the best, and not second-guess yourself if the decision turns out less than completely successful. Unfortunately, nobody can truly predict the future.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY