Bone around tooth root still not healing after 3 years - apicoectomy


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Oct 6, 2021
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Hello,
I had an apicoectomy on a lower molar around 4 years ago. About a year ago I had a CBCT done and found out that the bone one of the root tips did not heal yet.
Can someone please provide me with some explanation to why this could have happened? is it possible that there is an ongoing immune reaction to the synthetic membrane put inside to accelerate bone healing? or is this due to the bacteria?
I have an unexplained jaw pressure and problems since 2 years. Could this be related to that non-healing bone?

I had an another apicoectomy on the other side 2 years ago (where the extracted tooth location is), but had weird complications there and decided to get the tooth extracted 8 months after the operation. The extraction wound did not heal properly due to unknown reason. I had to go to a biological dentist who opened the wound again, scraped it properly and closed it back again. Now it is better.

I have erupted wisdom teeth, however the lower ones are still pushed back into the jaw as there is not much space left for them.
The upper ones are a bit sideways and the is not much place for them either but all 4 are not "severely" impacted in that sense. I sometimes have soreness around the upper wisdom teeth. Could this jaw pressure be caused by them although they are not "visually" pressing towards nearby teeth?

I attached a picture of the CBCT of the tooth in question (apicoectomy). Also an older panoramic picture where the wisdom teeth are visible (before getting the one tooth removed).
 

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honestdoc

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I noticed 2 endodontic schools of thought about failing root canals. The older endodontists will do more apico surgeries while the younger ones will do root canal retreatments and less apicos. It makes sense because doing apicos without resolving internal disease will fail to heal. However, my observations are that teeth with multiple attempts at root canals are much more prone to root fracture. Many times the more predictable option for failing RCTs is to consider implants.

Are your upper wisdom teeth tipped more towards your cheek? I see the lower right 3rd molar root apices are very close to a major nerve. If you're older than 25 years old, it can be more traumatic to remove your wisdom teeth since your bone is more dense and hard.
 
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@honestdoc thank you for taking the time to answer me.

So if I understand you correctly, you cannot really tell me or know the reason why do I have such a relatively large unhealed chunk of bone after so many years? can the bacteria be so powerful that the body could not deal with it or does this suggest the existence of another accompanying condition?

Yes the upper wisdom teeth are slightly tilted towards the cheeks. The pressure feeling I have is in the upper jaw as well. And I have been having it for about 2 years so far. And no doctor is able to tell me what is causing it. Could those two wisdom teeth be the culprit?
Unfortunately I am almost 30. I was thinking of getting all of my wisdom teeth out to see if this helps with my chronic severe tinnitus. I was scared of the complications, and you have confirmed them to me. But I assume that removing the upper wisdom teeth shall pose no problem still?
 
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honestdoc

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There may be 2 possibilities for the radiolucency around the root apex. It could be a scar with no disease or there is still infection. Bacteria can get resistant (see Enterococcus Faecalis) but usually if the source of infection (internal root filling) is still there. Did you follow up with the specialist/surgeon who did the apico procedure?

Upper wisdom teeth are less traumatic to remove. If you're having problems there, then it will be more predictable to remove them. Having an experienced surgeon can best manage any complications.
 

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