Expert: Frederick R. Liewehr DDS, MS, FICD - 2/8/2005

Question
Dear Dr. Liewehr,

My girlfriend attempted to have cosmetic surgery on her teeth, but has suffered a variety of complications.  One problem was that dental material (cement of some kind) that was used to fill a root canal was pushed up above the root canal and into the gum area.  Several dentists, and subsuquently an endodontist tried to solve this problem but without success (including by root canal treatment), and the dental material has been pushed even further up.  My girlfriend suffers from severe pain and swelling in the gum area both in the front of the tooth and behind (the tooth is one of the front top teeth).  The endodontist now says that he must perform surgery by cutting the gum and taking the cement and infected soft tissue out from above, rather than through the tooth.  I realize that you cannot make any diagnoses online, but does this type of procedure seem generally appropriate given the facts above?  Also, what type of professional - endodontist, oral surgeon, or other - should be performing such surgery?  And finally, what are the potential risks of this procedure?

Many thanks in advance for your thoughts.  We have been through a lot and would really appreciate a response.

Jac Wise

Answer
Hi Jac,
   I would like to help you with this, but I am very confused about what you are telling me. I don't think I understand what has happened to your girl friend.
    What kind of "cosmetic surgery" did she have? Something with the teeth, involving bonding and so forth, or some periodontal gum surgery? How did whatever she had manage to affect the root canal filling?
    When you say the cement was "pushed above the root canal into the gum area", do you mean it came out of the crown end, which would be into the gums, or was it somehow forced through the root end into the bone? Was it the filling material (we call this gutta-percha) used down in the root, or the material used to close the top of the canal (e.g. a temporary filling material or something).
    If this material came out the root end, did that have anything to do with the cosmetic procedure, or was it what we call "overextended" during the root canal procedure? If it came out the gum end, was the tooth perforated? If so, was it due to a natural resorptive process, or did the dentist performing the root canal perforate it in the process?
    What type of surgery is being recommended? Is it periapical surgery by an endodontist, or gum surgery by a periodontist? What exactly do they hope to accomplish?
    When was the root canal treatment performed? Was it fine until the cosmetic surgery, or was there too short an interval to tell whether the root canal treatment was successful?
    As it stands, I really don't have a clear picture of what problem your girlfriend is having. If only I could see a photo and an x-ray, I could be a lot more help. However, if you can help me by answering the questions as best you can, and I can get an idea of the entire sequence of events, maybe I can be a little more helpful.

Dr. Liewehr