Obturating or not Obturating?

[Brause]

Pulpectomy on tooth 21 (upper incisor) performed 110 days ago. Better, but far from perfect. Has not healed completely. Calciumhydroxide did not completely remove the abscess/pain/infection/inflammation....whatever you want to call it.

Endodontist says it won't become better after obturation, but recommends obturation over extraction.

Strangely enough, problems with tooth 21 came on immediately after extraction of tooth 46. Tooth 21 was followed by teeth 36 and 41.

Got headaches, but it is not clear from which end...all of these are connected to the trigeminal nerve.

Endodontist sees the cause in all these teeth becoming symptomatic quasi simultaneously in wrong occlusion resulting in occlusal trauma following tooth 46 extraction. Hence he advises against further extractions.

Complex problem. Not sure how to solve it.

 

[Dr M]

Have you considered finishing the obturation and then maybe doing an apicectomy? Especially if there is still a peri-apical lesion present.

 

[Brause]

Have you considered finishing the obturation and then maybe doing an apicectomy? Especially if there is still a peri-apical lesion present.

No, because an apicectomy has only a success rate of 50%, and it takes 1/2 year to find out. Also, it would weaken the tooth even more.

Many clinicians generally advice against it.

What's weird: the scientific literature describes retreatment always as a procedure AFTER obturation.

My endodontist also advises against from further extractions, as they promote more traumas from (a crooked) occlusion. The fact that several of my teeth became symptomatic quasi-simultaneously, he blames on occlusal trauma following the extraction of tooth 46 and endodontic pathology of tooth 21 [necrotic pulp].

And, truly, having to work around the socket of tooth 46 and a sensitive tooth 21 resulted in really "crooked" chewing/biting.