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Old 12-22-2010, 08:32 AM
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Apicoectomy (dental surgery)

I was told by an endodontist that I need to have this procedure done due to a failed root canal. After doing some research online I'm pretty terrified. I'm getting a second opinion on Monday but If anyone had it done, please share your experience. Thank you in advance.
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Old 12-22-2010, 08:33 AM
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I'm sure Pam (idalis), who is a dentist, will be able to provide some insight.
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Old 12-22-2010, 08:42 AM
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OH haiiiii. Apicoectomy was the last word I would have imagined seeing on my homepage this morning

Anyhow, the success, and also the difficulty/risks and post-op course of this procedure depends heavily imo on what tooth number it is, and what the current condition of this tooth is. Tell me what tooth it is and I will give you a better idea of what to expect.

An apico is basically a reverse root canal, which aims to clean the infection starting from the source at the end of the root, rather than from the top of the tooth down. A little window (flap) is cut through the tissue adjacent to the tooth and the bone, to expose the infected root apex, then the area of infection is cleaned out, the root tip is amputated, and the end of the root is sealed.
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Old 12-22-2010, 08:58 AM
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Hi Pam
The tooth number is 19. I had a root canal done about 5 years ago and had an abcess a year later that was treated with antibiotics. The root canal specialist told me that the root canal looked good and just to watch it. The abscess site never filled in with bone but never bothered me either until about a year ago when it would get sore now and again. There are 2 dark spots next to the roots now on the X-ray, they are not very big and I feel no pain. I was wondering if a second root canal would be an option as the whole apicoectomy procedure seems very drastic and scares me to no end.
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Old 12-22-2010, 09:03 AM
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Well, unfortunately lower molars are the most difficult apicos, and also carry the greatest risk of nerve damage (to the nerve that supplies sensation to that side of your jaw and lip), tend to be the longest healing period, and have, in my experience, the worst long-term prognosis.

You have abscesses around both roots of the tooth?

Has extraction and implant been presented and discussed with you as an option.
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Old 12-22-2010, 09:11 AM
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PS: Yes, a root canal retreat is another option, however this will 1) require cutting through the crown I presume is on this tooth, which may destroy it and require you spending another $1000+ on a new one, or at minimum will possibly shorten the lifespan of said crown; 2) may not clear the abscess collection; 3) there may be some small extra canals that were missed the first time, which may also continue to be inaccessible by this approach a 2nd time (missed canals I'd put up there as the #1 cause for a root canal failure, however the fact that you have PAP's on both roots is of concern to me); 4) is equally or more costly than the apico
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Old 12-22-2010, 09:14 AM
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Yes, the abscesses are next to both roots, but they are relatively small ( compared to what I saw when I googled the images for a dental abscess). I'm really worried about the nerve damage as well after reading stuff up online. The doctor did mentioned an extraction to me, but said that the tooth itself was strong and he would not recommend it. But I'm still considering it. Do you think there is any chance of success with a second root canal at all? Or is there are a way to inject antibiotics or something like that through the tooth?
Thank you so much for your responses, I appreciate them very much.

Last edited by Green_Tea; 12-22-2010 at 09:32 AM.
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Old 12-22-2010, 09:26 AM
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I didn't see your second post before I posted.
What do you mean by the worst long term prognosis of the apico? Is there are a high chance of the roots getting infected again or a high chance of complications?
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Old 12-22-2010, 09:36 AM
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I'm sure you must have seen extreme horror-cases of abscesses online Most of them are not massive black holes, but rather tiny little balls at the ends of the roots.

No, antibiotics can't be injected, and are not a resolution to this problem. This is a chronic infection of necrosis. Just like when you took antibiotics for the flare-up you had once, you can take them and knock down the bacterial count, but as soon as you stop taking them the infection just starts rebuilding. Also this infection exists in an avascular (not well supplied by blood) space in the bone which means it is hard for antibiotics to even get there to work. When we clean out root canals during RCT treatment we sterilize the canals with what is essentially bleach, but especially in the case of small accessory canals, this is not always effective either. The root sealer aims to completely close off the canal space so that any bacteria left in there cannot live anyway.

Is the endo planning to do the apico himself, or does he refer to an oral surgeon? Just being honest here, as a general dentist who performs neither apicos nor implant placement (or root canal retreats for that matter... send em to the endodontist, take too long and too many headaches), keep in mind that a person who performs only one or the other of these may be slightly biased in which you should have Though at least he did present extraction/implant to you as an option. I will just say that this would probably be the definitive solution most likely to last you the rest of your life, however obviously you will be without a body part. Retreat vs. apico, both carry a greater chance of failure, though either MAY be successful.

Wish I had a film of this tooth.
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Old 12-22-2010, 09:42 AM
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Quote:
Originally Posted by Green_Tea View Post
I didn't see your second post before I posted.
What do you mean by the worst long term prognosis of the apico? Is there are a high chance of the roots getting infected again or a high chance of complications?
Correct, higher chances of the procedure not successfully resolving the issue. When we say "prognosis" of a tooth, we basically mean what are the chances this tooth will end up being a lost cause and need to be extracted.

I would consider a lower molar double-root-apico a last-ditch resort for someone who really is super against having a tooth extracted and wants to try anything to save it.

One last question - was the original RCT done by a general dentist or an endodontist.
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Old 12-22-2010, 09:56 AM
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The endo would be doing it himself. I don't have the film unfortunately, I gave it to the endo yesterday, I wish I had taken a picture. The original RCT was done by I believe an endodontist that came to my general dentist's office. After what you've said and more online reading I'm leaning towards having a root canal retreatment and if it does not work having the tooth pulled and getting an implant or a bridge (the tooth next to it #20 has a crown on it already anyway). Is it true that I would need to wait a year after the extraction before i can get an implant?
I will see what the other endo says on Monday and may come back with questions before I decide Thank you again for all of the information, it's been very helpful to me
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Old 12-22-2010, 10:08 AM
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No that is not true that you'd have to wait a year. Some can even be placed at the same time the tooth is extracted, depending on how clean the extraction site is. You DO have to wait about 6 months after placement of the implant fixture before you get the crown put on it, this is the time during which the implant integrates with your jaw (bone grows around the implant fixture). IMO, there is no reason to choose a bridge over an implant if you have the bone for the implant. An implant is more conservative, longer lasting, and is about the same price as a 3 unit bridge when it comes down to it.

I don't want to tell you what to do, especially given that of course I cannot see this tooth, but I think your thought process at this point is where it should be. An apico is not an inappropriate choice by any means.... but of the 3 it is the one I would most refer to as what I call "hero dentistry" (you're a hero if you save the tooth with it... if not, well it was a really sick tooth to begin with and you did the most you could)
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Old 12-22-2010, 11:37 AM
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Omg, all this "Apico" stuff sounds so scary I unfortunately will be getting my wisdom teeth out, probably within the next year, though I know it isn't as bad as what your having to get done, Green_tea... Good luck, by the way, I really hope everything goes well!!
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Old 12-22-2010, 12:22 PM
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Actually, hate to say it, but the post-op healing period for an apico is generally speaking much better than for 4 impacted wizzies
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Old 12-22-2010, 12:29 PM
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I would rather give birth to triplets naturally and with no drugs, then to have my impacted wisdom teeth extracted again.
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Old 12-22-2010, 01:20 PM
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^same. It was worse then natural birth for sure.
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Old 12-22-2010, 01:57 PM
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^^ That's weird because I had both of mine pulled and ate pizza the next day. Easiest procedure ever.
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Old 12-22-2010, 02:03 PM
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Experiences will vary widely. It depends on a lot of factors, including the position of the tooth (and hence the difficultly in removing it), the surgeon, and just the individual's body in general.

My brother had one of his taken out a few months ago, and he was totally fine right away too. Told me "people take vicodin for this shit?"
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Old 12-22-2010, 02:26 PM
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^ Oh I am sure. The last one I had pulled was on the top. I was numb for the procedure but it hurt A LOT afterwards. And I developed blisters in the back of my mouth....that sucked. I am by no means tougher than anyone else. I just had a wonderful experience with my bottom wisdom teeth.
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Old 12-22-2010, 03:21 PM
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Ugh, you guys are making me cringe!

Oddly enough, I never developed wisdom teeth - they don't exist on an x-ray. My father didn't either. Both my mom and brother did have them.

Pam, is it true that with evolution, people won't get wisdom teeth anymore?
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Old 12-22-2010, 04:08 PM
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Well, for whatever reason, congenitally missing teeth are indeed becoming more common. Not just wisdom teeth, but actually more commonly upper lateral incisors (the ones next to your front teeth) and premolars. My personal feelings are that it is some combination of A) people losing less teeth over the lifespan and not needing the "spares" (wisdom teeth come in so much later, on the possible reasoning that by age 18 our caveman ancestors would have lost many teeth and needed some more) and B) humans' heads are getting smaller
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Old 12-22-2010, 05:01 PM
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Wow, cool!!!


Quote:
Originally Posted by idalis View Post
Well, for whatever reason, congenitally missing teeth are indeed becoming more common. Not just wisdom teeth, but actually more commonly upper lateral incisors (the ones next to your front teeth) and premolars. My personal feelings are that it is some combination of A) people losing less teeth over the lifespan and not needing the "spares" (wisdom teeth come in so much later, on the possible reasoning that by age 18 our caveman ancestors would have lost many teeth and needed some more) and B) humans' heads are getting smaller
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Old 12-22-2010, 09:47 PM
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I would rather give birth to triplets naturally and with no drugs, then to have my impacted wisdom teeth extracted again.

i refuse to have my wisdom teeth out because i am absolutely terrified of it. *cringe* i remember when my brother had his out and how disgusting it was. thankfully they all grew in straight/upright and haven't caused me any issues *knocks on wood*

Quote:
Originally Posted by idalis View Post
Well, for whatever reason, congenitally missing teeth are indeed becoming more common. Not just wisdom teeth, but actually more commonly upper lateral incisors (the ones next to your front teeth) and premolars. My personal feelings are that it is some combination of A) people losing less teeth over the lifespan and not needing the "spares" (wisdom teeth come in so much later, on the possible reasoning that by age 18 our caveman ancestors would have lost many teeth and needed some more) and B) humans' heads are getting smaller
really? i don't know why but i LOLed thinking of future people with little tiny heads


Green Tea I hope it all works out for you in the end, good luck!
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Old 12-22-2010, 09:59 PM
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I have all four wisdom teeth, but I still have one baby tooth! There was never a permanent tooth underneath. It's one of my lowers.
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Old 12-22-2010, 10:06 PM
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really? i don't know why but i LOLed thinking of future people with little tiny heads
Yes. Even in just the span of recorded history, faces and jaws are getting smaller and smaller.
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