Abscess Healing Time after RCT

[Brause]

Abscess Healing Time after RCT: published accounts range from 2-3 days to 3 months. What is realistic?

After how many days without feeling improvement should you start worrying?

 

[Dr M]

I usually start worrying after about 4 weeks. If the abscess was large and chronic, it can take 6 months to a year to clear up fully and sometimes granulation tissue has to be removed as well.

 

[Brause]

Thanks. RCT was performed 6 days ago. No improvement so far.

X-ray from immediately before RCT. Periapical abscess is not big at all. Widened PDL space could point to a simple occlusal trauma or a VRF (from trauma).

Pulpa was largely necrotic, but some was still vital/iniflamed/painful.

In order to eliminate future trauma from bruxism, a custom-made mandibular night guard was finished two weeks ago. Also makes no difference.

I am going to see a periodontist for an implant soon. Could he do something in this case?

 

[Dr M]

He will take a CBCT scan and then if a vertical root fracture is identified, extract the tooth and maybe discuss an implant. The bite plate should help, as long as it is thick enough and hard. A lot of times additional medication is prescribed to be used in conjunction with the bite plate. If bruxism still continues, further investigation is required. Might be a TM-joint disorder

 

[Brause]

The problem with CBCT scans: the resolution is not very good...see that fuzzy one attached.

Apparently, even at the most favourable settings, only fractures wider than 0.15 mm can be detected.

Since most fractures in frontal incisors (#21 in this case) are buccal - lingual, better resolving regular X-rays could work better, provided the clinician gets the imaging angle right (looking along the suspected fracture).

Another problem appears to be the root canal geometries in incisors: their cross sectional geometry may change from coronal (round) to apical (elliptical)....and the apical part may not receive an effective treatment.