Apicoectomy recovery - should I be concerned (X Ray Attached)?

[AW89]

Hello! I hope someone here can help ease my mind.

I had a RCT on my maxillary lateral incisor in August 2022. It would ache intermittently so I went for a follow up. It was found to be slightly overfilled and I was recommended an apicoectomy. The apico. happened on 27 March 2023 - so, 6 weeks ago.

Since then, I have had bouts of pain and tenderness in the tooth. They tend to happen every two weeks and can range from general achiness to a sharp pin-like pain at the surgical site. No swelling, redness or pustule, just pain which generally disappears after antibiotics.

I did go back for a follow up bc I was concerned and was told there is no infection acc to the X-rays. They said that it is possible that some minor disturbance was upsetting the tooth. I can believe that since I tend to push at it with my tongue and other teeth and also tend to grind my teeth (trying to stop).

(EDIT: I forgot to mention that I was also given a resin composite 'splint' applied to the apico. tooth to give it some structural integrity. This happened about 3 or 4 weeks after the apico since the pain kept coming and going.)

I also got a CT Scan done on 4 May and got a second opinion. Again, the doctor saw no trace of infection. I have been told it is a normal part of healing and that it's only been a few weeks so I should be patient and just let it heal at its own pace.

That sounds right but I am still a little concerned that the pain seems to come and go. If it is related to the healing, why is it not more constant? Why does it disappear and come back? And why does it 'wander' and go from dull to sharp and back?

I would be very grateful for any insight. I attached the latest Xray here.

Thank you in advance!

 

[MattKW]

Looks reasonable on the OPG. I would prefer to see 2 smaller fine detail dental xrays taken just before surgery, and most recently. Usually there is a small degree of neural disturbance from the surgery so it may never feel quite normal again. You wouldn't expect to see significant bone healing show up for 3-6 months post-op; that's when you get a final fine detail dental xray.

 

[AW89]

Thank you so much for your reply. The OPG is the most recent Xray I have and I don't currently have a pre surgery x ray, but I do have some others:

one from 7th April - 2 weeks after the apicoectomy (Scan 3)
and one from 27.04 which was taken when the resin splint was applied (Scan 2)

Please do note however, they were taken by at two different clinics, not the same one.

I hope that helps. In your opinion, is the recurrent pain a permanent issue or does it resolve as the bone grows? I wouldn't expect it to feel normal again (I am already used to the strange 'gap' like feeling at the sinus) but I do really hope the pain stabilises, it is so exhausting. Thank you again for your guidance, I really appreciate it.

 

[MattKW]

Nothing there of significance. I think you'll just have to wait and see a bit longer. You shouldn't be taking antibiotics unless there is obvious selling or pus.

 

[AW89]

No pus, no swelling, not even redness. Nothing but regular bouts of pain. I have been told that there is no trace of an infection but I am still very nervous - I guess because every source online insists that pain should not persist beyond 2 weeks. I should stop obsessively looking for quick solutions and focus on healing, I guess.

*Also, my mistake - I wrote I was taking antibiotics in the original post when I meant painkillers (Seractil/Dexiibuprofen 400mg; usually for 3-4 days when there is pain).

Thank you very much for your guidance, Dr Matt. Appreciated.

 

[AW89]

Nothing there of significance. I think you'll just have to wait and see a bit longer. You shouldn't be taking antibiotics unless there is obvious selling or pus.

Can I please ask your advice again, Dr Matt? I am once again experiencing sharp pain despite being on ibuprofen for 5 days. It flared up today without any warning and is worse than before. Can you please let me know any possible reasons for such recurring pain? Is this at all normal? There is no pus or any visible signs but it feels like a knife in my gum. How long can I depend on dexiibuprofen 3 times a day for this ordeal?

 

[cocoanuts]

@MattKW Do you have a response to AW89's question? Thanks so much.

 

[MattKW]

If you are surviving only due to painkillers, then unfortunately perhaps it's time to extract. I've had a couple of these intractable problems in my lifetime too.