Please help. I need opinion regarding 3rd Apicoectomy.

[poby]

I've had teeth problems all my life. It really really depresses me.

This tooth #9 (3rd front tooth) was a nightmare. I had root canel done when I was a kid many years ago. In 2001, a cyst was found and I had my first apicoectomy to have it removed. The tip of the root seemed to heal okay and the hole (where the cyst was before) got smaller, but my bone never grew back to fill up the hole. 4 years later, the same endo that did my api found recurring infection at the tip of my tooth. Therefore, the 2nd api was performed. She opened my gum up, cleaned my infection, and saw that the "hole" was "scar issue built up", and left it alone. (I later learned that she could have cleaned it up and put "bone graft", but she didn't)

Now it's another 4 years, and my infection came back. I don't know what to do now. I got different opinions from 2 endos and my dentist. The endos think they can do it the 3rd time (cutting more tooth, since the infection seems to originate from the tooth, not the 'hole'), but they had no idea about the successful rate. My dentist suggested that I just leave it as is (it doesn't hurt, only once in a while I felt a little bit weird and very minor pain for a day, and it will go away) until hopefully years later, when I MUST do something about the tooth, extract it and do an implant.

I am really lost now. I don't really trust the same endo but I don't know who to go to? I know a really good oral surgeon. Should I ask for his advice? or should I try and find another endo (one that can perform bone graft if I go for 3rd api)? I really hope to keep my tooth (instead of implant) if all possible, but I also don't want to suffer the 3rd time for nothing. I am in great fear and I worry about this everyday.

My situation is so complicate. Can someone please help me? I don't know who to go to and what to do... Thank you so much. (attached is my x-ray taken in May. infection was found earlier this year)

 

[Gordon]

The x-ray you posted, do you have one taken a bit earlier or a bit later? It would be interesting to see if there are changes to the lesion.

There is a very sharply defined border between bone and defect on the top of the film, that looks very like a cyst to me, so I'd be inclined to suggest going into it surgically, but it might just be that the last surgical intervention hasn't healed yet, which is why it would be nice to see older or newer x-rays.

Personally I'd go with your general dentist, take regular x-rays to check that the cyst isn't growing, say every 3-6 months and save the money towards an implant.

 

[poby]

Thank you Gordon. The 2nd time when my Endo opened my gum up to do 2nd api, she said that there were no cyst, it was just scar tissue... the recurring infection seemed to come from the tip of the root.

Here is another X-ray from last year in October. I think it changed a tiny bit (where the infection is, the infection seemed to spread out a little bit more).

Does this information change your opinion regarding implant or 3rd api with bone graft? Also, if you still recommend implant, do I need to "close the hole" first before I can do an implant (meaning, my implant process will take much longer = wait even longer without my front tooth? that would be a nightmare!!!)?

Thank you so much for replying...

 

[Gordon]

It looks better in the May film than in October, so I wouldn't do anything, just wait a bit longer and take x-rays to keep an eye on it.

I wouldn't do a 3rd apico, like I said, I'd save the money for an implant, I'm not an expert at placing implants, but the "hole" could be sorted at the same time as the implant was placed, I think.
Going by those films though, there is a chance that there will be good healing without further surgery.