Tooth pulsating after apic surgery


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Hello I had a root canal years ago on tooth number 9 under my nose few months ago it started to hurt dentist sent me to an Endodontics he performed an apic said tooth wasn’t fractured good prognosis so about 4 months later tooth is pulsating especially while bending down swollen way above tooth almost under nose but no pain and pulsating comes and goes went back for check up while just finishing a antibiotic for in related sinus infection Dr said no infection and bone growth is great and showed me it was almost grown in from my bone loss around that tooth so he said the filling is only about a centimeter not 2-3 centimeters as is normal on my tooth root tip because of my larger post in that tooth. He said it will take about a year or more to fully heal due to the size. I’m not sure what to do but know something is going on maybe a leak or he did a bad job? It was expensive and do not want to have my tooth pulled any suggestions? Ty
 
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MattKW

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I've done many apicectomies/retrograde fillings in my younger days. The long term prognosis of a tooth with an apico can be fair because if the root apex has been reduced, you are at increased risk of vertical root fracture. The most likely sign sof this would be tenderness, mobility, isolated periodontal pocket, apical gumboil, and Xray changes. Do you have any Xrays to show us taken immediately before and after apico, and more recent ones?
 

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I've done many apicectomies/retrograde fillings in my younger days. The long term prognosis of a tooth with an apico can be fair because if the root apex has been reduced, you are at increased risk of vertical root fracture. The most likely sign sof this would be tenderness, mobility, isolated periodontal pocket, apical gumboil, and Xray changes. Do you have any Xrays to show us taken immediately before and after apico, and more recent ones?
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I unfortunately don’t know the correct order of photos and I don’t have the X-ray that was mostly recent whereas he said bone is growing back very nicely thank you in advance
 

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It should also be noted that at the check up a week ago there is no mobility as opposed to before surgery and X-ray shows improvements, he throughly inspected the tooth under his state of the art micro equipment didn’t see a fracture I believe thus far based upon your experience that I have either a boil, or cyst? Also if no fracture what would be the treatment drainage via an incision?
 

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MattKW

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Thank you, I can see what's happened and work out the order.
BEFORE APICO: When your received the 1st RCT, the dentist then placed a post. The post went too deep -blue arrow- and almost certainly penetrated the side of the tooth (a perforation) - red arrow. He didn't cement the post to full depth and this was a place for bacteria to create the abscess and bone loss.
AFTER APICO: The endo has done a very good job considering the circumstances. He has filled the gap -green arrow- and repaired the perforation as best he could, probably with MTA. Your abscess has definitely decreased in size -white arrows-. Bone filling in -yellow arrows.
It's a very weak and damaged tooth. I would leave it alone and re- Xray in 6-12 months to check further progress. Don't bite on this tooth, it's just there for appearances. This is as good as it gets. Start saving for implant(s).
 

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Joined
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Thank you, I can see what's happened and work out the order.
BEFORE APICO: When your received the 1st RCT, the dentist then placed a post. The post went too deep -blue arrow- and almost certainly penetrated the side of the tooth (a perforation) - red arrow. He didn't cement the post to full depth and this was a place for bacteria to create the abscess and bone loss.
AFTER APICO: The endo has done a very good job considering the circumstances. He has filled the gap -green arrow- and repaired the perforation as best he could, probably with MTA. Your abscess has definitely decreased in size -white arrows-. Bone filling in -yellow arrows.
It's a very weak and damaged tooth. I would leave it alone and re- Xray in 6-12 months to check further progress. Don't bite on this tooth, it's just there for appearances. This is as good as it gets. Start saving for implant(s).
Thank you very much for taking the time to explain it’s much appreciated. Notes, these teeth have been crowned since the 90s from an accident. My primary concern is the tooth beating on and off with a tender area just below my left nostril. No pain at any rate and X-ray shows nothing but bone growth. Just wondering what these symptoms are? Seems to me like something isn’t right Endo wants me back in approximately 5 months for check up. Is it still healing? Will have to hold out until something drastic comes along because the implant as you are aware is not only expensive but something I don’t want to do but will have to at some point.
 

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MattKW

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At this stage I would await further healing as the endo suggests. When apicos are done, it is not uncommon that patients report some disturbed nerve sensations because the surgery results in some minor and unavoidable damage. Unfortunately, nothing can be done about that - it may be something you have to live with. It's not something that further surgery (or antibiotics) will achieve anything better. You'll just have to be patient and hope it subside further over the next 6 months - by then it will be as good as it gets. Pls drop a message back here at that time - I'd be interested to hear how it feels and what the next Xray shows.
 

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