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Old 01-13-2011, 10:26 PM
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Apicoectomy vs Extraction and implant

I hope Idalis will be willing and able to help me! I read on a previous thread that you are a dentist!
I had a root canal done on my tooth (one just back from the left front tooth on the top) about 20 yrs ago (I was in junior high then). Started to get discoloration above the tooth on the gums a couple of years after. Then I got a crown on that tooth in 2001. 2 weeks before this past Christmas (2010), my youngest hit his head on my chin as he was standing up (it was only very lightly). One of my bottom teeth pressed on that tooth and that was the first time I felt pain in it. That same week I went to see a dentist as the pain was just getting worse. The x-rays showed infection, she put me on antibiotics and referred me to an endodontist whom I saw this morning. He recommended the apicoectomy. My concern is: this tooth being right in front and at the top, what is the chance of the hole in the bone not healing and leaving a defect under the nose? With the success of the apicoectomy lasting only a couple of years, what is the reason for trying to 'save' a tooth? Why rather save it than just extracting and getting an implant? What I'm also wondering about, would the dentist be able to see on the x-ray if there is adequate bone for an implant? Or is it something that can only be determined after extraction? I don't know what to do and could really do with some advice!
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Old 01-13-2011, 10:50 PM
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Barring a fracture in this tooth, which I assume they have checked well for (this would be my primary suspect on a tooth with sudden onset pain following a trauma), I would say get the apico. Implants in the aesthetic zone (front teeth) are THE MOST difficult area in terms of aesthetics regarding bone and gingival contour and tooth length. Upper anterior apicos are the easiest area, and there is zero concern with a defect under the nose, that's not within the realm of the procedure. I think you are magnifying in your head the scope of the hole that is made to access the root, and there is essentially 0 chance the surface area will not fill with some bone unless you have some very serious medical problems, in which case you shouldn't be having any of the above procedures to begin with. Also I'm not sure where you are getting your information that apicos only last a few years. People live their entire lives with apico'ed teeth. Others fail immediately. There is no guarantee of any particular result.

Oh, and regarding bone for an implant, this is determined via xrays. In some cases an oral surgeon would take a CAT scan even.
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Old 01-13-2011, 11:21 PM
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My sister was bounced off a trampoline & landed on her face when she was little. She knocked her tooth & the dr's repositioned it & left it. It has been discolored & kinda turned but it had lasted. Now, 20 years later she just had it extracted by the dentist I work for. The plan was to do the extraction, bone graft, & then implant in time.

When the tooth (#7) came out the doc was surpised that she had so much more bone loss & no buccal wall (is that right Pam?) so it is an extremely difficult case. She might not ever be able to have an implant. The doc doesn't think so. They did a bone graft & placed a membrane but now they just wait. My point is, they did not see that much bone loss in her films & now she has no tooth. She might end up with a bridge at 34. That sucks.

I'd do everything you can to keep your tooth.
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