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Does an Apicoectomy hurt and is it worthed?

I

italiannyc17

Well-known member
Joined
Jan 30, 2011
Messages
109
Location
USA
I had a root canal about 3 months ago and the tooth still has pain ONLY if I push down on it. I went back to the dentist and he took an xray and said that I need an Apico because there is still an infection on the bottom and a redo of the root canal wouldnt work.

Question 1 is does the procedure hurt and is it painful after?

Question 2 is, is it worthed to get it done? I already spend 900 for the root canal with post and core. Im spending another 600 on a crown, and now probably another 700 on this. Should I just get the thing pulled? Wont it have to be pulled down the line anyway. I heard these things dont even have a 100% success rate. Im 26 years old btw.
 
Question 1 - no, you are fully numbed. Afterpain should be usual soreness handled with OTC painkillers.

Question 2 - maybe not. Which tooth is it? Second molars are supposed to be really difficult. First molars ok to do. It is surgery so I would say only view it as last resort, after an endo has deemed the tooth doomed because they have done the rct themselves and therefore have faith that it is not a missed canal that is causing the issue.
If the endo knows there is an issue, say a curvy canal which they could not get to properly using non-surgical rct, then an apico may have a good success rate. I was warned one of my rcts might need this down the line.

In other words I would try a re-treat by an endo first, not just go straight to apico on the recommendation of a general dentist. If the cause of the problem is a missed canal, an apico won't solve it and you will have undergone unnecessary surgery. Sometimes apico is done because there is already a crown in place rather than removing the crown and re-doing endo. This is not what you want either.

It seems it is better done by a surgical endo rather than an oral surgeon in general.

Believe it or not, I was surprised to read that there is also an option when endo and apico fail (say because of a crack) to extract the tooth instead of continuing with the apico, without damaging it and re-implant it after treating its faults while it is out of the mouth. Seems amazing, no idea how common it is. For endos only I think ;).

Depending which tooth it is, you may want to leave things for now or just opt for extraction should it become problematic.
It is simple in the scheme of surgery though, so if you want to keep the tooth at all costs in the right circumstances it may be worth a shot. The success rate goes up massively if it is done by an experienced endo in the appropriate circumstances i.e. not just because no one wants to remove a crown.
 
I'd just add that really complicated apicoes can/should be done by an oral surgeon. My abscess on a prior rtc x 2 teeth turned into a granuloma (cyst) and the apico was done to save the teeth by the surgeon at the same time he did the cyst removal and bone graft with guided tissue regeneration.

Had an endo tell me once the apico should hurt no more than a root canal after- during is painless with good local.

rp
 
I'm a dentist and I pretty much agree with brit. Here in the UK there are clear guidelines that apicectomy should only be done after re-endo, unless a specialist says that re-endo can't be done.

Re-endo with a specialist, apicectomy, or extraction and replacement... there isn't always a right or wrong answer, certainly not between one of the first two and the latter. You need to see what your priorities are and your attitude to risk. If you are willing to take a risk and save money in the short term go for an re-endo/apicectomy. If you want the most predictable solution, go for extraction and implant. The influencing factors are many and very personal.

An important clinical factor is which tooth it is. Can you tell us?
 
I'm a dentist and I pretty much agree with brit. Here in the UK there are clear guidelines that apicectomy should only be done after re-endo, unless a specialist says that re-endo can't be done.

Re-endo with a specialist, apicectomy, or extraction and replacement... there isn't always a right or wrong answer, certainly not between one of the first two and the latter. You need to see what your priorities are and your attitude to risk. If you are willing to take a risk and save money in the short term go for an re-endo/apicectomy. If you want the most predictable solution, go for extraction and implant. The influencing factors are many and very personal.

An important clinical factor is which tooth it is. Can you tell us?

First Molar on the lower left. The dentist told me he is going to talk to his colleague who is an oral surgeon that I would go 2 and get his opinion on it also. I asked my dentist about a redo and he said it wouldn't work to do it again. Hes a very honest and caring dentist so hes not just trying to avoid doing it. Must be a reason why he thinks it wont work. Im going to ask him when he calls me.

Take into account also that I waited years to get this root canal and when I finally went I was in extreme pain. I felt nothing during the root canal and was so happy when he did it. No more pain at that time lol. I was on antibiotics for a week before the root canal and a week after.
 
A re-do by an endo might work though. A microscope helps a lot.
I've read that an oral surgeon is not the best choice for apico (if not complex like RP's case with cyst involvement) as they don't have the training/skill/equipment for cleaning out the end of the tooth after removing the tip. A surgical endo does.

Lower first molar is an important tooth re chewing. More so than a second.
 
So I had a nice long convo with my dentist. His friend is going to give me the consult for free and probably give a ct scan on the tooth to make sure it can even be done. He said he will only charge me 400 for the procedure which is actually REALLY GOOD cuz my dental plan charges 870 for it. Then he said he will work with me for the crown. He said the tooth was really complex and he just doesnt believe another redo will work.

He said the apico should work but its not 100 percent and he said the OS will have a much better idea of if it has great success or can be done from the things hes going to do during the consult. He also said that if it cant be done, the tooth will have to be pulled, and we would have to put an implant in, which he will also work with me on the price.

Only problem is that I wanted braces and he said that tooth is an ancor for them. He doesnt like the idea of putting it on an implant. He said something about it being 2 strong, so only time will tell what will happen. Ill give more details after I have my consult with the OS.

Overall hes an awesome dentist and I trust him.


Also, whats everyones opinions on it. Even if I can get the apico , and then the crown on it .. Should I just get the implant instead? Might not have a choice in the end
 
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Having taken into account all you have said, I still think you should ask yourself about why they could be making these recommendations with free consults and discounts offered and not considering getting a consult with an endo specialist as to the viability of a retreat?

Implants don't last forever and the longer you can put them off the better maybe. It depends on your age, finances and attitude to dental treatment maybe.

All an apico does, is to remove the last 3 mm of the root tip (there's more than one root on a molar - do they know which one is causing the problem?) and it is true there is complex anatomy in that last bit of the root but it is also equally true that if the original endo were done without the benefit of a microscope, then there could be missed canals which if found will clear up the infection (this would be non-surgical unlike apico or implant).

I had an root canal done by a General dentist which lasted for 19 years and at the retreat the endodontist found several missed canals. The general dentist had told me it was calcified and he couldn't get very far. It may still need an apico but if it does they are confident which root is the likely cause of reinfection (the curvy one).
If the original root canal was done by a General dentist (whether your current one or not), I would want to be referred to an endodontist for an opinion on retreatment before considering apico and extraction/implant. As I said the lower first molar is worth keeping.

NB If you go for retreat with endo not general dentist, do not even consider being talked into a crown until the tooth has settled down after the endo. The endo needs to place a permanent filling though to stop the entry of bugs.

NB2 I am not saying your dentist is steering you wrongly, just that can he really say as a General dentist that a molar tooth cannot be saved by a retreat? If he did the original endo, he is likely less willing to believe that it could be improved upon but they usually can if magnification was not used originally.
Why can't he get his best endodontist to have a quick looksie to advise whether you have more than one option here?
To some extent the choice is yours but you have to identify what could be motivating particular recommendations when there is likely more than one option. TBH my concern is that the consult with the oral surgeon is free because it is really an implant consult.
If you share my suspicions even a little bit, you might want to say that you appreciate the offer but as you would rather avoid any surgical intervention if at all possible, you would prefer an endo to have a look first re whether there is any mileage in a retreat.
 
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Having taken into account all you have said, I still think you should ask yourself about why they could be making these recommendations with free consults and discounts offered and not considering getting a consult with an endo specialist as to the viability of a retreat?

Implants don't last forever and the longer you can put them off the better maybe. It depends on your age, finances and attitude to dental treatment maybe.

All an apico does, is to remove the last 3 mm of the root tip (there's more than one root on a molar - do they know which one is causing the problem?) and it is true there is complex anatomy in that last bit of the root but it is also equally true that if the original endo were done without the benefit of a microscope, then there could be missed canals which if found will clear up the infection (this would be non-surgical unlike apico or implant).

I had an root canal done by a General dentist which lasted for 19 years and at the retreat the endodontist found several missed canals. The general dentist had told me it was calcified and he couldn't get very far. It may still need an apico but if it does they are confident which root is the likely cause of reinfection (the curvy one).
If the original root canal was done by a General dentist (whether your current one or not), I would want to be referred to an endodontist for an opinion on retreatment before considering apico and extraction/implant. As I said the lower first molar is worth keeping.

NB If you go for retreat with endo not general dentist, do not even consider being talked into a crown until the tooth has settled down after the endo. The endo needs to place a permanent filling though to stop the entry of bugs.

NB2 I am not saying your dentist is steering you wrongly, just that can he really say as a General dentist that a molar tooth cannot be saved by a retreat? If he did the original endo, he is likely less willing to believe that it could be improved upon but they usually can if magnification was not used originally.
Why can't he get his best endodontist to have a quick looksie to advise whether you have more than one option here?
To some extent the choice is yours but you have to identify what could be motivating particular recommendations when there is likely more than one option. TBH my concern is that the consult with the oral surgeon is free because it is really an implant consult.
If you share my suspicions even a little bit, you might want to say that you appreciate the offer but as you would rather avoid any surgical intervention if at all possible, you would prefer an endo to have a look first re whether there is any mileage in a retreat.


Well I mean I figure since the consult is free and everything they will do to check it out, I might as well go see what he thinks and has to say yano? Ill probably still end up going to an endo just to see what he thinks also.

My main concern is I know my general wouldnt even charge me for a retreatement of the RC if he thought it would work. The endo is going to charge me, and then if that doesnt work , id still be paying for a possible Apico and extraction and Implant if the apico didnt work.

I guess you can say every dental procedure has a risk to it. I just need to see which risk I wanna take I guess lol. I will probably see an endo for the hell of it if I can get a free consult from one.

When I got my root canal by my dentist, there was 4 canals found in the tooth. It was calcified also. He put some stuff in there the first time to help during the RC, and I came back a week later to finish it up.


The reason hes getting me discounts is because hes an out of network dentist. I went to him because of the many referrels from friends of mine who have went to him, and all the reviews online of the work he does. I could have went to an in network dentist and gotten all the work ive done for FREE. Instead I chose to go to him because hes kind, caring, and a great dentist. The people in my network ( public dentist ) dont care nearly as much. Had alot of bad experiences. So thats why hes trying to help me out with pricing. :)
 
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So I went to the consult today. I did not get charged for it , and also did not get charged for the cone ct scan. ( GREATTT MORE RADIATION )= [

The OS said that the tooth is complex and the apico would not be simple. He said there is risks with it because its very close to the nerve. He said that it would have a 50/50 chance of working on that tooth. He said he was surprised that when it toothed the tooth and pushed it was so sensitive. Was talking about chance of nerve damage if I get it done. Not a big chance, but still a chance.

To be honest, I really got the vibe from him that it wasnt going to work. He even said that if I had it done, he would have to be in a really good mood to do it because it would be difficult. He was joking about that obv. He was implying that it was very hard. The tooth has shifted and the bottom roots are almost sideways into the other molar next to it. He said the the root canal looked great and no canals were missed, but there was still problems. He said if I did the apico, he would cut a lil higher of the root trip then normal , clean it out, etc etc. This CT scan really gives you some crazy views of the inside of the tooth.

So I dont know what to do now. I voiced concerned about everything. He said if I wanna take a chance and do the apico, I could. He will only charge me 400 , instead of the 900 he usually charges because im friends with the dentist. He told me if I opt for the tooth to be pulled that my face structure wont change and he will pull it for free. Then I will have to have an implant put in at a later date. He said that it would be successful.

The weird thing is, he said that I would get the implant in AFTER I get braces put on and finished. My dentist said that I cant get the bottoms on UNTIL i get it crowned or have an implant because its an anchor for the braces. I do think I will get an ortodonist consult to see what another says.

All in All I have some thinking to do. I will speak with my reg dentist tomorrow after he gets the email from the OS about what went down.
 
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