Immense fear of apico done by oral surgeon instead of endodontist

[carrotbread]

Hello, I’m new to this forum and English is not my first language so I hope I’m doing this right.

Two years ago, one of my molars needed root canal treatment. Unfortunately, the root has become inflamed and my dentist has referred me to an oral surgeon to perform an apicoectomy.

However, I have now read on the internet that it is actually better to go to an endodontist and I have become super worried that the oral surgeon is not the right person for the operation. He also said that he might have to extract the tooth spontaneously if the inflammation is too severe. I have no pain and no abscess though.

What also worries me is that I keep reading that usually the next step after a failed root canal is usually a revision that is tried before an apico, but that was never talked about by my oral surgeon.

I don't have the appointment for another 6 weeks and can hardly sleep or eat because I’m so anxious. Are my worries realistic? Or is it just my anxiety speaking?

 

[Gordon]

It used to be exclusively oral surgeons who did apicectomy, it's a relatively new phenomenon that endodontists are moving into the area.

Practically speaking, it's more important that the person doing the treatment is experienced and knows what they're doing, rather than one speciality being "better" than another.

Retreatment may not be an option in your case, I don't know without seeing x-rays at least. Have you asked your dentist why they want to move straight to apicectomy?

 

[carrotbread]

Hello, thank you for the answer. I haven’t asked my dentist because I didn’t even question it as I wasn’t familiar with the process and didn’t even know retreatment was an option. I have an appointment with an endotonologist today for a second opinion. He’s gonna have a look at the X-rays. It’s another appointment so another cause of fear for me but if it means retreatment instead of straight apico I guess it’s worth the added anxiety.

 

[Gordon]

It would be interesting to hear what the endodontist thinks, can you update when you get the chance?

 

[carrotbread]

The endo told me he’d suggest retreatment over apico any day.

I’m from Germany where basic dental work is covered by insurance but root canal retreatments are not covered.
So the endo said that the normal route here is for general dentist to refer you straight to apico surgery because that’s what insurance covers.

I’m going to have to pay 1400€ out of pocket for the retreatment now but the doctor said success rate is 80-95% in my case so I will go through with it.

He also said the crown on my tooth is likely the cause for the reinfection because it wasn’t fitted well and there was a gap. (Which makes sense because the first root canal had to be done only 6 months after the crown was put on - and the crown was only done because my dentist thought of the previous filling as ‘too old’ but I never had any problems with the tooth for 15 years, it only started after having this crown)

I’m really scared of the retreatment especially because I don’t think I’ll be able to have my mouth open for 2 hours but I have a better feeling with the endo I’m now being treated by than the surgeon.

Oh and thank you for replying in this forum, I read some other threads with your insights- you really are helping people here!

 

[Gordon]

I’m from Germany where basic dental work is covered by insurance but root canal retreatments are not covered.
So the endo said that the normal route here is for general dentist to refer you straight to apico surgery because that’s what insurance covers.

That's really interesting. I always thought the Krankenhaus (did I spell that right?) system was more sensibly organised than our NHS but there you go.
I don't think that charge is unreasonable given what I paid for a fairly straightforward RCT a few months ago.

He also said the crown on my tooth is likely the cause for the reinfection because it wasn’t fitted well and there was a gap. (Which makes sense because the first root canal had to be done only 6 months after the crown was put on - and the crown was only done because my dentist thought of the previous filling as ‘too old’ but I never had any problems with the tooth for 15 years, it only started after having this crown)

Oh definitely. It's been suggested in the research that the coronal seal (the bit in your mouth) is far more important to the success/failure of a root canal than the apical seal (the bit in the roots). Pretty obvious if you think about it, most of the bacteria are in your mouth

I’m really scared of the retreatment especially because I don’t think I’ll be able to have my mouth open for 2 hours but I have a better feeling with the endo I’m now being treated by than the surgeon.

Agree a stop signal with the Endo dude first (they love it when you call them that ) and try a mouth prop (a sort of rubber wedge that's inserted to support your jaw and help you keep open without straining so much).

Oh and thank you for replying in this forum, I read some other threads with your insights- you really are helping people here!

That's very kind of you, thanks very much.