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Medical Forum / General / Dentistry / November 2006

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Could Apico have been avoided?

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Ned - 27 Nov 2006 16:20 GMT
My dentist sent me to a specialist to do my root canal.  I waited
several weeks and returned to my dentist to have the post installed. I
told my dentist I had pain and he took an xray but said he could not
see anything wrong. He said I might be sore for a few months from the
root canal and proceeded to install the post. Weeks later I was still
experienceing soreness and this time he sent me back to the person that
performed the root canal along with the original xray.  The specialist
noticed an infection and said I would need an apico.  I am wondering if
this could have been avoided had my dentist sent me back prior to
installing the post. The specialist gave me antibiotics and said he
would perform the procedure after new years because they will be closed
for vacation. This seems like a long time to wait with an infected
tooth.  Also, I was considering an implant but the opinions I have read
in this forum seem to point towards better success with the apico.

I would appreciate your input.

Thanks
NH
Mark & Steven Bornfeld - 27 Nov 2006 16:37 GMT
> My dentist sent me to a specialist to do my root canal.  I waited
> several weeks and returned to my dentist to have the post installed. I
[quoted text clipped - 15 lines]
> Thanks
> NH

    Last things first:  No one can assess the relative suitability of an
apicoectomy vs. an implant without specific knowledge of your clinical
situation.
    As to the substance of your question--when to restore a tooth that has
had a root canal and is still symptomatic is always a dilemma.  It is
true that sometimes teeth can be symptomatic for a long time--even
without any other indication (on x-ray, for example) that there is
anything wrong.  If restoration is delayed too long that incurs a risk
of re-contamination of the root canal system, to say nothing of fracture
of the non-restored tooth.
    However, I am personally hesitant to place a post in a tooth that is
symptomatic--on the chance that something like your experience happens.
 In any case, the number of posts being placed is diminishing, as the
place of posts in restoring endodontically-treated teeth has changed.
If I feel some kind of restoration must be placed, I will place a bonded
core and a temporary crown which can be removed if necessary.  If I feel
I must proceed with the permanent crown I will try to insert it with
temporary cement so that it may be removed if necessary.
    If your dentist had done this, it would have been easier to re-enter
the tooth to re-treat in the conventional manner, without damage to a
new permanent restoration.  However, we are presuming here that given
the choice the endodontist would have opted for conventional retreatment
rather than an apicoectomy.  This is not necessarily a valid
presumption.  It may be that knowing the tooth as the endodontist did,
the apicoectomy may have been the treatment of choice anyway--for
instance if he/she knew that there was an impassible canal.  In any
case, most posts can be removed--not all, but most.  So the placement of
the post--while inconvenient--does not necessarily prevent non-surgical
re-treatment.

Hope this helps,
Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

 
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