Recent apicoectomy on #7 and #8

[Rootcanalsuck]

When I was 10 years old I had a slight trauma to the front right tooth #8 my sister during horseplay I guess hit my tooth with a remote and it chipped exposing the pulp I guess so I had to get a root canal. Flash forward To when I was about 13(also around the time I got braces) I get a little what I now know is called a fistula above my #7 and it would wax and wane and I guess disappear at times, one time I went to my pediatric dentist and asked him about it and I believe he said it could be a bone fragment or something but it was fine for now because I wasn’t in any pain or anything, now I’m 20 years old and the bubble came back recently and this time it felt different and didn’t really hurt but it was draining a lot daily and I wanted it gone so I went to a new dentist who my parents had said they liked so I went there and they performed a root canal on #7 next time I go there I still have the fistula and then they take a 3D scan of my head and what I saw was bad looking, it looked like a big oval of darkness above #7 and #8, then I am referred to an oral surgeon who at first gives me some regular antibiotics and then another course of stronger antibiotics I believe it was called clavulanic acid and amoxicillin or something. Fistula still looks the same as it has if not worse, so I have the apicoectomy performed on 7,8 at the same time. 3 months later I have noticed that there is another big pimple looking thing starting to grow, what is my next option ? Should I just get it extracted and put implants i don’t have any X-rays yet but hopefully will soon these pictures are in chronological order, first one is like 6 days after the apico

 

[MattKW]

Xrays before RCT, after RCT, before apico, and after apico would be helpful to see how the history developed, and to give you a fair idea of prognosis. Sounds like the oral surgeon did the apicocectomy? Not the best people to do them, better to be done by endodontist. Implants are not necessarily the easy next step because you will probably have had significant bone loss.

 

[Rootcanalsuck]

I don’t have those at the moment but I will see about getting them as they are from 10 years ago, could you tell me anything based upon the pictures I posted going back to the surgeon to see what he says on Monday I’m not in paid so am I okay?

 

[MattKW]

You appear to have recurrent abscesses. Apicos have a significant failure rate.

 

[Rootcanalsuck]

Yeah I was aware of this, just got back from the doctor gave me amoxicillin and told me he wants to go back in, just took this X-ray today ... any suggestions... should I get a second opinion from another doctor... any reccomondations are aprreciated

 

[MattKW]

Yeah I was aware of this, just got back from the doctor gave me amoxicillin and told me he wants to go back in, just took this X-ray today ... any suggestions... should I get a second opinion from another doctor... any reccomondations are aprreciated

I wouldn't revisit an oral surgeon. If you want to really assess the chances of success, then see an endodontist. Your xray shows a couple of problems with heavy-handed apicos: the initial damage to the tooth was when you were young and the canals were large (hard to root-fill), the apices have been opened up widely following the apico, so more foreign material for the body to try to counteract, and there's no apparent end sealant to the apicos - an endodontist would prob use some MTA. i don't like your chances, but an endodontist is the best person to consult.

 

[Rootcanalsuck]

Can you elaborate on “heavy handed” Apicos, I was expecting to see a little hole where he drilled through bone? I can’t tell so does it look like he did that? And because the tooth has been in my mouth for so long and never got capped or anything is that possibly why I have this problem to begin, also if I go to an endodontist will they treat me after I had the apico done by another surgeon?

 

[MattKW]

Can you elaborate on “heavy handed” Apicos, I was expecting to see a little hole where he drilled through bone? I can’t tell so does it look like he did that? And because the tooth has been in my mouth for so long and never got capped or anything is that possibly why I have this problem to begin, also if I go to an endodontist will they treat me after I had the apico done by another surgeon?

• Heavy-handed because of the amount of root tip removed, and the amount of root filling thereby exposed. And there doesn't appear to be any sealing of the apex. In the old days, amalgam was used to seal the apex; it worked reasonably. I did plenty of those myself. Nowadays, an endodontist would remove a very tiny tip of the root, and seal up with a more biocompatible material like MTA.
  
• The lack of a cap (crown) is not significant in your case. It would not have given much benefit as there's not much tooth structure in young teeth. On the plus side, it also means that without a crown, an endodontist will be able to more easily get into the canal from the mouth end if necessary,
• The bone heals over in most cases. In your case, the bone is thin because of the recurrent infection - that's why you have a gum swelling.
• You have nothing to lose by seeing an endodontist. Their techniques have improved so much over my lifetime. That's why i'd never use an OS for an apico.

 

[Rootcanalsuck]

Thank you so much for all the responses, this is just a scary time in my life as I’m only 20 years old and pretty self conscious about having missing teeth possibly in the future or if this problem never goes away because of the extent it has gone on. I’m afraid it’s going to spread to the adjacent teeth or something. But anyways I will see an endodontist and see what they say.