Failed Apicoectomy

Discussion in 'Dental Archive' started by Wilhelm, Sep 28, 2004.

  1. Wilhelm

    Wilhelm Guest

    Had root canal. Still infected. Had apicoectomy, waited 6 months.
    Seems it is still infected.

    Endodontist said large dark region around tip may NOT be infected -
    just "connective tissue" that grew in before bone could. I am
    doubtful. Particularly as I can *feel* the 'infection' ebb and flow -
    the same as it did before all of this. And the x-ray is basically
    identical to those taken earlier.

    Endo said he cannot be sure it is infected - even if ihe goes back in
    to take a look.

    I said I want that infection out of there at any cost. He said even
    extraction may leave an infection there if it is in the bone.

    I am utterly exasperated with no clear idea about what to do. I don't
    have unlimited funds to get a bunch of second opinions and I've
    already blown a bundle trying to fix this problem.

    1) How likely is it that this new x-ray is showing something other
    than an infection?

    2) Is there another way to determine whether the site is infected?

    3) An extraction could leave the site infected ... really???

    Thank you all kindly.
     
    Wilhelm, Sep 28, 2004
    #1
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  2. Wilhelm

    JWN DDS Guest

    Wait. Give it some time. Unless it really hurts I would wait and see how
    things heal.

    jwn dds

    "Wilhelm" <> wrote in message
    news:...
     
    JWN DDS, Sep 28, 2004
    #2
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  3. Wilhelm wrote:
    Understand that I am going to talk averages here--your case may be
    different.
    If the tooth is tender over the tip of the root, it is very likely
    there is residual infection. However, scar tissue doesn't look too
    different from a chronic abscess, so it can't always be ruled out by x-ray.
    Many teeth that have failed root canals do not respond to apicoectomy.
    There may be a small canal the endodontist has missed. Commonly there
    is an undiagnosed root fracture. The location of the dark area on x-ray
    can give a clue to this.
    The chances of the infection remaining after extraction are very, very
    small.

    Steve
     
    Steven Bornfeld, Sep 28, 2004
    #3
  4. On 27 Sep 2004 18:40:57 -0700, (Wilhelm) wrote:

    NAH!

    You are unduly concerned. Whatever it is (granulation tissue, most
    likely) it is walled off so do not fear.

    Joel
     
    Joel M. Eichen, Sep 28, 2004
    #4
  5. On 27 Sep 2004 18:40:57 -0700, (Wilhelm) wrote:
    VERY!

    Granulation tissue means connective tissue that will not organize
    itself into bone. (SIMPLE EXPLANATION - not exactly precise).
    What means "infected?" That means presence of bacteria, viruses, etc.
    Are you aware that our entire bodies are covered with bacteria? They
    slide in and out of our fingernail beds and every orifice?
    Nah. If you yank it, the dark radiolucency (ball) comes out.

    If it did not that would be NICO, that is nonsense.

    Joel M. Eichen DDS
     
    Joel M. Eichen, Sep 28, 2004
    #5
  6. Wilhelm

    W_B Guest

    On 27 Sep 2004 18:40:57 -0700, (Wilhelm) wrote:
    relatively common
    no not really
    Strongly disagree !

    $2 says that the root is vertically fractured.


    --

    W_B

    Take out the G'RBAGE
     
    W_B, Sep 29, 2004
    #6
  7. Wilhelm

    W_B Guest

    On Mon, 27 Sep 2004 22:28:56 -0400, Steven Bornfeld <> wrote:
    Yeah, what he said.
    --

    W_B

    Take out the G'RBAGE
     
    W_B, Sep 29, 2004
    #7
  8. Wilhelm

    Dr Steve Guest

    I'll take that bet and raise you $4
     
    Dr Steve, Sep 29, 2004
    #8
  9. Wilhelm

    Wilhelm Guest

    > >
    Of course. And I am also aware that an infection at the tip of a root
    can spread, evidently did spread (to adjacent two teeth - which *did*
    respond to apicoectomies) and should be dealt with.

    And you didn't address my question. But thanks anyway ...
    So you are certain of that. And if the infection remained ... sounds
    like your world would be rocked.

    Anyway, thanks for you reply.
     
    Wilhelm, Sep 29, 2004
    #9
  10. Wilhelm

    W_B Guest

    On Wed, 29 Sep 2004 18:45:45 GMT, "Dr Steve" <> wrote:
    I see your raise and call...
    --

    W_B

    Take out the G'RBAGE
     
    W_B, Sep 29, 2004
    #10
  11. Wilhelm

    Wilhelm Guest

    > Understand that I am going to talk averages here--your case may be
    Thank you. Your reply makes sense and parallels what my endodontist
    said.

    He offered three ideas about what to do:

    1) go back in and this time fill the area with calcium sulphate - if
    only to alleviate my concerns about the dark area on the x-ray,

    2) redo the root canal,

    3) wait another 6 mos. (also advice offered here, I noted). This is
    the advice he finally settled upon. Your view on this?

    Do you know of another method of ascertaining the presence of an
    infection? Seems a simple needle extract from the affected area
    should provide a lab specimen. (My endodontist said perhaps a
    University can do this but wasn't sure.)

    Thank you.
     
    Wilhelm, Sep 29, 2004
    #11
  12. On 29 Sep 2004 13:43:23 -0700, (Wilhelm) wrote:
    NOPE!

    I have never seen a locus of infection (periapical - around the root
    tip) that was NOT WALLED OFF!

    Joel
     
    Joel M. Eichen, Sep 29, 2004
    #12
  13. Wilhelm

    W_B Guest

    On 29 Sep 2004 13:55:46 -0700, (Wilhelm) wrote:
    Would be my first choice, bone heals slowly, may even take a year.
    As long as there is *no* pain.
    Not really, diagnosis is determined by objective signs and symptoms.

    Can you post a picture of an x-ray of this area ?
    It would be better than shooting in the dark for us.
    Unreliable and almost impossible to do in the oral cavity.
    --

    W_B

    Take out the G'RBAGE
     
    W_B, Sep 29, 2004
    #13
  14. Wilhelm wrote:
    This will make for a prettier x-ray, but won't address any infection
    issues (if any)
    This MAY work. Is this the same endodontist that did the original root
    canal treatment? If not, and especially if this endodontist uses an
    operating microscope (becoming pretty standard for endodontists in the
    US), there is always the chance that he may find another canal. But if
    the same endodontist is treating you, and magnification was used before
    without finding any additional canals AND assuming this is a
    high-quality endodontist AND assuming there were no known special
    problems with this tooth (root perforations, blocked canals, etc.), it
    is very likely a retreat will not accomplish anything. The endodontist
    should give you some guidance in this regard; he should be able to
    hazard an educated guess as to whether he is likely to find anything
    overlooked on the first try that could make the difference between
    failure and success.
    I think the assessment of Dr. Steve M and WB may be correct--there may
    well be a fracture. But this is far from a certainty.
    On the one hand, the chances of this turning into a roaring toothache
    are fairly small (though not zero). My feeling is that if there is
    discomfort after 6 months, there will PROBABLY be discomfort after 12
    months. There are 3 possible outcomes:
    1) The tooth recovers--obviously, this is the hoped-for outcome.
    2) The tooth gets worse--if there is a fracture, sooner or later the
    tooth will deteriorate. Typically, if there is a vertical root
    fracture, infection will spread from the salive down the fracture by
    capillary action, eventually leading to looseness of the tooth, some
    swelling and soreness. The treatment is extraction--any other treatment
    is a waste of time.
    3) The tooth remains the same. If this remains about the same, you
    really have to look at your level of discomfort about the tooth. You
    can continue to wait indefinitely of course, and follow clinically and
    by x-ray. While this option may not give you psychological peace, it
    will give the greatest chance that any subsequent treatment performed
    will be appropriate.

    In practice, this isn't done to my knowledge. The sample is too likely
    to be contaminated by saliva, and if the needle is misdirected I'd guess
    it's easy to get a false negative as well.

    Steve

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld DDS, Sep 29, 2004
    #14
  15. Wilhelm

    Josh Brower Guest

    Extraction would not leave it infected. Oxygen hitting gram - bacteria from
    infection would kill them all. Wouldn't jump to anything even if xray shows
    nothing different until have pain in tooth. May take a long time to heal.
    If apico was done right antibiotics can clear up residual infection. JOsh

    "Wilhelm" <> wrote in message
    news:...
     
    Josh Brower, Sep 29, 2004
    #15
  16. Josh Brower wrote:
    Agree with your conclusion, but not with your premise. What gram
    negative bacteria did your culture disclose, Doctor?

    Steve

    Wouldn't jump to anything even if xray shows

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld DDS, Sep 30, 2004
    #16
  17. Wilhelm

    Wilhelm Guest

    Mark & Steven Bornfeld DDS <> wrote in message news:<>...
    First off, thank you very much for your very helpful replies thus far.

    On the calcium sulphate - your view and the endodontists' are
    identical.
    Read and understood. (In fact, it was a *dentist* who did the root
    canal).
    A bit of a news flash here:

    To get to the heart of the matter, in the past 12 hours I've wiggled
    the tooth a bit and poked the gum firmly (once, a few times) with my
    finger up toward the root tip. This always exacerbated the problem
    before and, sure enough :), it has exacerbated it again. I can now
    *taste* the 'infection'. Some of you will roll your eyes here, I
    imagine.

    I suspect the infection leaks out at the gumline at the rear of this
    upper lateral. Is this common? Or likely? Or uncommon?
    Impossible??

    In any event, the feeling now of slight swelling, the taste, and
    slight physical awareness in the gum is similar to what it was before
    any work was done (though now the swelling is minor).

    I feel convinced the infection exists. Yes?

    Someone placed a wager on this being a root fracture though the
    original message is missing in my google news session ...

    Can the endodontist find a confirmation of this? Then, according to
    advice here and with the support of the endodontist, it seems the next
    move is reasonably clearcut: extraction.

    Have I got this right?

    Thank you all.
     
    Wilhelm, Sep 30, 2004
    #17
  18. Wilhelm

    W_B Guest

    On Wed, 29 Sep 2004 19:27:12 -0400, Mark & Steven Bornfeld DDS
    <> wrote:

    And O2 only kills obligate anaerobes.

    --
    W_B



    Take out the G'RBAGE
     
    W_B, Sep 30, 2004
    #18
  19. Wilhelm

    W_B Guest

    On 29 Sep 2004 22:04:30 -0700, (Wilhelm) wrote:
    Don't do that !!!
    Who knows at this point, quit messing with it.
    I bet $2, SM raised me $4 and I called.
    If the root is vertically fractured then yes.

    --
    W_B



    Take out the G'RBAGE
     
    W_B, Sep 30, 2004
    #19
  20. On Thu, 30 Sep 2004 05:22:10 GMT, W_B <> wrote:
    Gotta be careful here or the ozonologists will be back in here
    .........


    Joel
     
    Joel M. Eichen, Sep 30, 2004
    #20
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