Expert: Ketan Amin, DMD - 8/4/2006

Question
Thanks for your prompt answer.  Am  I correct that even if there is bacteria in the canal which can't be cleared out, it will not affect the tooth or root once it get the 5 mm seal?
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Followup To

Question -
I have a post inserted into a front upper tooth, to which a crown is attached.  The space inthe canal above the post is not filled in.  There is an abcess at the root tip.  I am considering a apicoectomy. I understand that the endodontist will be able to go only 5mm into the root once the tip is cut off.  Can the he sterilize the canal down to the top of the post.  If he can't, will there be subsequent infection.  My regular dentist thinks I should forget apic and do implant.  Your comments please

Answer -
Hi John,
The 5 mm root end filling during the apicoectomy should provide a sufficient barrier to prevent any communication between your tooth and the bone; and allow the bone to heal normally.  The success rates in surgical endodontics with modern techniques is roughly 86-92%.

I imagine this crown was done a long time ago...it would be malpractice for someone to just put a post in a tooth without a proper root canal done by an endodontist.

Since this is a front tooth, I would attempt the apicoectomy, keeping in mind that nothing is 100% including the implant treatment plan--however the front teeth are easier to do apicoectomies on and you can expect a better result.  

Implants are great for people who already have missing teeth however when considering removing a tooth you have to remember that implants take a long time (6 months to a year) to be fully loaded and integrated; in addition, esthetics in the front is very important and often metal from the implant shows after gum recession, so ideal esthetics is difficult to obtain.

Nothing is better than your natural tooth:  your general dentist should be the first to remember that since that's his/her job!!

Best of Luck,
Ketan Amin, DMD
www.rootcanalspecialists.org

Answer
As long as the bacteria in the canal are seal adequately within the root canal system, they will not elicit an immune response and associated bone loss.  The anaerobic bacteria in the root canal system do not produce acid, so they do not cause "decay", and won't affect the root.

Best of Luck,
Ketan Amin, DMD
www.rootcanalspecialists.org