RCT has been infected after 5 years... what are my options?


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Hi

I had a RCT in 2013 and yesterday, suddenly i started to feel a lot of pain in the gum covering that teeth. I went to the emergency dentist and he told me that the RCT was unsuccessful and i had an infection there.

Im already taking amoxiciline, but i would like some advice on what should i do once the course is finished

My first concern is... what is wrong with that? How come after 5 years without any problem suddenly i have that big infection?

Going further, apparently i have three options, as i have been told that if i dont take any action once the antibiotics course finishes, it will be infected again

1 - Try to do another RCT again
2 - Have an apicoectomy
3 - Extract the teeth and have an inplant


Option 1 seems to be the best for me, but im worried as i have read that success rate on retreatments is low

Can somebody give some help on this?

Thanks
 
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MattKW

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So much depends on why the original RCT failed. At the very least, I'd need to see an Xray image.
 

MattKW

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Thanks for that. You have 2 RCTs - lower right and upper left; neither of which are in good shape.
  1. Upper left molar has obvious periapical infection around mesio-buccal (MB) root. There are a couple of possible reasons: perhaps there is another canal (called MB2) which has not been root filled ( I can't tell from this Xray alone), or that the MB and the distobuccal (DB) are underfilled. This tooth would be best retreated by an endodontist, with probably good results.
  2. Lower right molar has definitely underfilled distal (D) root, and possibly underfilled mesial roots. Again, seek endodontic opinion for retreatment as first option.
You also have to consider probable costs of having to rebuild the fillings or crowns on top of these teeth.
If unable to do these teeth again, then extraction is the way to go. Apicocectomies would be fraught with difficulty and unlikely to get you out of all this trouble.
 
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Thanks for the detailed explanation. I was told that the bottom right one was successful but I will ask this to be checked as well

Regarding the infected one (upper right), once this heals, how long do you reckon I have to have this RCT corrected? It might take one month until I have this done. How likely is to have another infection there in that period?

Thanks
 

MattKW

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The antibiotics are just an emergency measure, and their use and effectiveness is unpredictable. No need to wait till end of antibot course, try and make appt for as soon as practicable. If the infection flares up again before you can see endo, then you can either try another course of antibots, extract the tooth, or have someone with experience try and get into the canal to clean it out a bit (difficult). If the infection really gets bad despite antibots, then be prepared to extract rather than risk full blown facial infection and poss hospitalisation. Good luck.
 
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After one day I need to say that the infection has nearly gone so I’m responding well to amoxicilline.

Related to this, as it was done 5 years ago, and was faulty since then, what could be the factor that has started this infection? And what is more interesting, am I more exposed to infections there now than when I had the rct done?
 

MattKW

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After one day I need to say that the infection has nearly gone so I’m responding well to amoxicilline.

Related to this, as it was done 5 years ago, and was faulty since then, what could be the factor that has started this infection? And what is more interesting, am I more exposed to infections there now than when I had the rct done?
Your body can tolerate some degree of infection. I have seen patients with huge abscesses that give them no pain, until one day...
Now that it has started to give you trouble, it will come back again unless you have treatment. Antibiotics have given you breathing space, but will not keep it under control for very long. Act on them ASAP.
 
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If a root canal isn't done perfectly and sealed perfectly with a crown then there is always a chance it will fail. You're lucky it lasted five years. Make sure you see an endodontist who specialises in root treatment. It's worth the money. Infections can be serious, get it seen to soon. Let us know how you get on but don't leave it to get worse or spread to other teeth. Best of luck and please do send an update.
 
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