Oral Surgery/Tooth #30 - Apicoectomy vs Extraction
QUESTION: Dear Dr Teig,
Thank you very much in advance for helping me make a right decision. My tooth 30 had a root canal treatment 2 years ago and had a crown placed immediate after the root canal treatment. I then had root canal retreatment after 6 months due to on-going slight pain sensation, which I can still feel it after the retreatment. The good news is that I have been able to use tooth 30 normally so far.
Recently I found that my gum is swelling around tooth 30. I went back to see my endodontist. The x-ray has suggested that there is an infection around the middle section of tooth 30 (represented by a dark spot in x-ray). The image of the bone at the tooth root tip is beautiful. I have been suggested for an apicoectomy procedure to save the tooth.
My concerns are:
1. My understanding is that Apicoectomy will remove and clean up the entire tooth root tip. Can Apicoectomy procedure save my tooth since the infection on my tooth is not at the tooth root tip?
2. What is the success rate for apicoectomy procedure?
3. Would apicoectomy cause bone damage thus it would ruin the chance of implant if the apicoectomy failed to save my tooth?
Thank you so much!
ANSWER: Chris - any possible success is the cause of the infection. Is it from the end of the root tip or as you describe more towards the crown. The question I have and any surgeon who might attempt the apicoectomy is if the problem just from the root or from a crack in the tooth. The location of the problem is not a good sign. A simple apicoectomy works well if done by a skilled surgeon. Unfortunately, an endodontist is not a surgeon and often there attempt at this surgery does not come out very well.
An apicoectomy does cause bone additional bone damage (if there is an infection, the site of the infection has bone damage)while doing the surgery. If all the infection and the cause of the infection is completely removed then this can be successful. If the problem is not due to an infection from a root, the success rate is not high. In this situation I would suggest having the tooth extracted, the infection scooped out and let the bone heal for about 3-6 months to allow new bone to form. At the time of the extraction no bone graft at that time due to the existing infection. Many doctors place a graft at the same time with extracting an infected tooth, but many times the graft is lost. So a conservative healing of the extraction site is most important before an implant and/or a bone graft is placed.
I wish you well. If you have further questions, feel free to contact me again.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Teig,
Thank you so much for your quick response. I just received the image of my tooth #30 taken recently. I am thinking perhaps it might make a difference if you could see the precise location of the infection. Please see the attached picture.
As you can see from the picture, the location of the infection appears to be at a triangle area between 2 root canals. Can you tell that the cause of the infection is from the roots or more likely from cracks in the tooth? Would there be any hope to save my tooth?
Thank you very much again!
Chris - Whether the area of infection at the crotch between the two roots, where they are attached to the crown, is from a crack in the tooth, a hole placed in the root from the root canal treatment or just an infection from a microscopic nerve canal, the tooth does not appear salvageable from an apicoectomy. So unfortunately, the extraction is the correct treatment and let the area heal for a few months before any bone or implant is placed. Again no graft at the time of the extraction.
Sorry for the bad news. Any more questions, feel free to contact me again.