Treatments for failed root canal?

[Gr8K8]

What are the indications for an apicoectomy or other endodontic surgeries?  I'm under the impression that these are last resort treatments for a failed root canal. I'm told this is not possible for #3, on which I had a root canal on 3/27/07. Pain/pressure continued; had redo on 5/7/07 where canals were left open; crown resealed with temporary filling, and antibiotics. I noticed on the xray that the tooth looked overfilled -- asst. said this will be reabsorbed into body. Tooth was closed on 5/22/07.  During "closing," endodontist found drainage in distal and buccal roots (this tooth has 4, there's some bone "involvement," and called it abscessed.  His assistant explained that closing the tooth can "dry up" the infection.  Antiobiotcs prescribed as well as continuing with ibuprofen 600 mg every 4h as needed.  Still pain/pressure -- some days are mild.  Endodontist gave me option of more antibiotics or extraction (I chose antibiotics). What????  No interim step to save this tooth??! This doesnt' seem right. It was explained to me by his assistant that a lesion needs to be present for an apico, which I supposedly don't have; that an apico take 6 mos to 1 yr to develop and that this tooth is not that "severe" yet. Any info on this matter would be appreciated!

[Jerome Bogin, D.D.S.]

I would think that if the endodontist didn't give you the option of an apico then he thinks it would not be  an effective treatment for this tooth. Over the years I have been more apt to extract the tooth rather than refer the patient for an apico. In the long run I do not think they are very successful.

[mike1105]

i agree w the forum doc. apicos are not my favored treatment anymore--- especially on molars and especially since implant technology has become so reliable. there may be a small fracture in the root(s) somewhere, or there may be acessory (extra) canals. Not all root canals work. If it were my tooth I'd prefer to have it extractd and have an implant placed if he root canal treatment is deemed to be a failure.

[Gr8K8]

With apicoectomies, what are some reasons against doing them?   I just hate to lose this tooth and would prefer to do (almost) anything to save it.  Thanks.

[mike1105]

an apicoectomy involves removing what is though to be the cause of the infection by going through the gum and bone and removing the end of the root and placing a filling in the end of the root. The main reason NOT to do an apico is that they do not have a justifiably high success rate (in my opiniion and the opinion of many). They are even more difficlult and less likely to work on molars. they are also quite expensive. the thought process is twofold: 1. not to try to be a hero--- if it continually causes problems and expense, just remove it and place an implant, which may very well be needed anyway (after the apico has failed). 2. implants have become the most reliable, and best way handle these cases.

More food for thought--- apicos require removing bone. implants are placed into bone. If an apico does not work and the infection grows ("dissolving" even more bone) you are left with a situation that is NOT ideal for the placement of an implant. In other words, doing an apico can compromise the success or even the ability to place an implant later on if needed.

[Catalin P]

I'm in a similar situation with a tooth that was closed after an unsuccessful RCT.
The doctor tried to clean the root but each time root still have bad smell.
Finally he closed explaining that are good chances to heal if is properly closed.
So the tooth is now cemented with a post inside.
I'm taking cephalexine.
I still have pain when I press the root with my finger.
The question is, it is possible for the root to heal in time or the infection will remain painless destroying the jaw bone?

[mike1105]

if the infection clears up, it may come back again depending on how well (or poorly) the root canal was done, whether ot not there are any fractures or accessory (extra) canals, or other resons why root canals failed. I certianly would not allow any more treatment on this tooth until you've been asymptomatic for a moth or two while NOT on any antibiotics. If it does flare up again, insist on seeing an endodontist (root canal specialist) who uses an endodontic microscope. In my humble opinion ALL root canals should be done in this manner becasue they have the best equipment and therefore patients have the best chance at successs.

[stormsight]

I had a root canal last October that failed and a apico was done (this was on #25). Now I am having odd sensations and discomfort where the work was done. Is it possible that the apico has failed, and if so, what happens now?