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Oral Surgery/Post Apical Surgery Recovery


QUESTION: Dear Dr. Ryan,
I had an apical surgery 5 weeks ago to take out the lesion at the apics of the root. Following the surgery, I initially recovered very well. However, I feel pressure/tightness on the gum and the tooth and warmness near the surgical site and that side of the nose. When my mouth makes slight movement, it feels that something is pulling the gum/tooth. Is this normal 5 weeks after the surgery? How long after apical surgery should this sensation disappear? Some websies seem to suggest that recovery time for apical surgery is only 2 weeks. Many thanks.

ANSWER: Jill, Thank you for your question. 5 weeks seems like a long time to recover from an apical surgery. It would be worth calling the surgeon or endodontist to get their opinion. It might be time to consider extracting the tooth or a course of antibiotics to see if it settles down.

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QUESTION: Many thanks, Dr. Ryan. My endo prescribed a course of antibiotics the following day after my message to you. The warmness near the surgical site and the side of the nose has disappeared. Though I still something is pulling the gum/tooth when making certain movement. IS this normal? Is this because of the bone is missing there? Or does it indicate that there is still inflammation or infection? The tooth is No.9.

ANSWER: Jill, The feeling of the tissue being pulled is quite normal. Especially in the front because the tissue is ultimately connected to the lips. As the scar tissue heals, this feeling should resolve. However, it does seem like a long time at this point. Usually it takes a few weeks to resolve but can last longer. If it is not better in a few weeks (7-8 weeks after the surgery), have it looked at a again to make sure everything is going well. Please keep me updated.

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QUESTION: Thanks, Dr. Ryan. I finished the course of anti-biotics and went to the endo today. She took X-ray and checked the gum and the tooth. She does not think I should be concerned, but told me not to use the tooth for another 4 weeks. If the feeling does not go away in 2-3 weeks, I will have it checked out again. Will X-ray of the tooth show tissue/bone infection?

Jill, an x-ray of the tooth may show a bone infection. The information you get from an x-ray after endo treatment is not great because it takes a few months for the bone to fill in so its difficult to tell if the infection has resolved. A series of x-rays (periapical) will show if the infection is resolving but this may take months. The problem is that you are still having discomfort. I think the plan you have is good. The peridontal ligment around the tooth might be inflamed, therefore, not using that tooth for a bit might settle things down. I like the plan you have.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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