Apicoectomy, extraction, or wait and do nothing

[PetLover]

I a new poster to this forum, although I am an avid reader and this forum has helped me a lot over the past year. Let's just say that the dentist's chair is not my idea of the ultimate vacation.

I have two ancient root canals that were recently diagnosed with chronic periapical periodontitis. The failed root canals are greater than 10 years old, and there has been a substantial bone loss. I have already seen an endodontist and he has suggested an apicoectomy for one molar on the upper left side (can't recall the number) and extraction of the second molar (#2), which is adjacent to an implant and has also experienced tooth fracture. I am not experiencing pain in either, and they were found through routine x-rays, and then follow-up with the 3-D camera. I will;l; require an implant for the extracted tooth.

Presently both the endodontist and periodontist have suggested that I take a "wait and see approach," and suggested that I NOT do anything until some type of pain or the bone loss worsens. We will monitor with x-years and a 3-D camera on a quarterly basis. Bone grafts are already required for both sites, so I'm not convinced that waiting for something to get worse before doing something is the best strategy for me. However, I realize that there are mixed opinions on when one should surgically treat chronic periapical periodontitis. My periodontist is VERY conservative and will only extract a tooth when necessary, both wisdom teeth on the right to go this spring.... but when another dentist suggested that I remove the removing wisdom teeth ( as a precaution). he declined.

I tried to bring up this up during an implant check and got nowhere. I think I'm not asking the right questions. It is my health and I need to have a better understanding of why they think doing nothing until things worsen is the best approach. I also have no ideas about the success rate of a root canal failure for an upper molar. The same for implant success with extensive bone loss and te type o grafting. I realize I may be premature... but I need some answers. What type of general questions can I present to these dentists to get some type of conversation going? I'm sure they have a valid reason for their suggestion, but I have to know and understand what it is. I'm the ultimate decision-maker when it comes to my health, and until we get a decision on what the are thinking I am just comfortable with what they have proposed.

Can you just provide me with 3 very basic general questions I can present to these dentists as to when it is is the best time to perform an apicoectomy or extraction for chronic periapical periodontitis with bone loss. I need these guys to talk and allow me to part of this decision making. Many thanks.

 

[drhirst]

Hi Petlover,
I would ask them to describe to you the risks vs the benefits of either doing nothing, extracting or attempting and apicectomy.
I would also ask if having a chronic infection on a tooth adjacent to an implant is putting the implant at risk. In my opinion if the infection is anywhere near the implant the tooth should be treated in one way or another to prevent the infection reaching the implant which could be very bad for the implant.
Lincoln

 

[PetLover]

Thanks for the feedback. Regarding, "I would also ask if having a chronic infection on a tooth adjacent to an implant is putting the implant at risk. In my opinion, if the infection is anywhere near the implant the tooth should be treated in one way or another to prevent the infection reaching the implant which could be very bad for the implant," I had an implant checkup with the periodontist on Friday, and I asked him about the risks associated with the infection/bone loss so close to the implant. He felt that the bone loss was not adjacent, but rather opposite the implant and posed no risk. Infection...dormant at this point. He wasn't concerned about it. But yet they asked me to follow up on the shadow on the x-ray. I am getting such mixed signals here!

I understand that technologies and procedures have advanced, maybe become routine, and most problems can be addressed.t I DON'T want extensive surgery to fix something that should have been addressed earlier. I have trusted this dentist to date and really don't want to go "dentist shopping," but this is really bothering me. Any tactful question I can pose that says yes I heard what you said during our appointment but I really don't understand....?