Complex issue: relates to Apico and error in way performed

[Kaleidocoke]

Hi all,

I have got a slightly unusual / complex issue and I was wondering if anyone can share their advice with me.

The following has happened (I ll try be as comprehensive as possible).

1: I had a root-canal done at tooth A6 (top left, near back)

2: The tooth has 3 canals. When my dentist did the root canal, he provisionally filled 2 canals but left the third one unfilled with a medical preparation to fight an infection. He then provisionally placed a crown on it.

3: I had to go travel for business. Unfortunately, the neighbouring tooth started hurting and an infection developed above the tooth in the gum.

4: I returned home to see my dentist but he was on vacation. So I went to see another dentist.

5: The other dentist treated the tooth that hurt (A7) and then turned to the infected one (A6). He took an x-ray and did not realise that one of the canals in A6 had not been filled (to be fair to him, it was very hard to see on the xray). He thought all canals had been filled.

6: The only solution to fix the infection therefore, he thought, was an Apicoectomy, which he performed. However, he did not seal the tooth from the bottom (i.e. at the root end - not sure why to be honest).

7: After a month or so, I went to see my regular dentist who had returned from vacation. He said that the apicoectomy should not have been performed since not all canals were filled at the time. He then re-did the root canal on A6 and filled all canals. He then permanently sealed the tooth with the crown.

8: My regular dentist said that he suspecs that the tooth may not have been sealed from the bottom, but he could not be sure and he did not want to re-perform surgey on "suspicion" that this had not been done.

9: Since then, I have spoken to the other doctor and know for sure that the tooth has not been sealed from the bottom.

So this is the whole thing. I am really not sure what to do now. I am supposed to travel on business to Asia for 6 months soon and I am really worried that something will get infected.

Can anybody comment on the importance of sealing a tooth from the bottom (i.e. at the root end) when performing an apicoectomy? Is there any chance of this staying ok the way it is?

The tooth is not painful anymore although I can feel that it is a little sensitive to knocking and pressure. This has really been giving me sleepless nights.

Thankful for any comment / help.

 

[brit]

Hi
Sorry to hear about your troubles. I am writing this as someone who has experienced two apicos both done by the same endodontist on two different teeth and only one of which worked. The failed one is now an implant.

It is really unusual for General Dentists to do apicoectomy - it is something classed as surgical endodontics. It seems to me that the second dentist was in far too great a rush to do this procedure and it doesn't seem like you were given a rundown of the pros and cons etc etc .

I do know that it is normal procedure to always re-do a root canal at least once before resorting to 'apical surgery' but if surgery is done, a microscope is supposed to aid in the process and it is part of the process to retro-fill the end of the tooth where it has been cut away.

Are you sure you had an apico? You need heavy duty local anaesthetic and it involves drilling through the bone.
If you end up with a failure maybe dentist 2 needs to be funding your implant? Good luck.

 

[Gordon]

To get back to your question, although it's routine practice to do an apical seal (the posh name for what you're talking about) it's not vitally important. I'd be a bit concerned that somebody performed an apicectomy on a relatively difficult tooth (an upper molar) without apparently knowing how to do a standard procedure like an apical seal.

Having said all that, the main thing that contributes to success is how well the canals sealed up from the mouth end. A good crown with an indifferent root filling will be more successful than a crap crown with a great root fill.

If the tooth is generally symptom free, I would try not to lose too much more sleep over it.

 

[Kaleidocoke]

Thanks very much - this is actually quite comforting.