It was closer to 1.5k. At this point I am feeling mighty
mistrustful of the endodontist who did this work. He gave
much more hope that the apicoectomy would work, AFAIC.

I am not going to complain. But I learned about implants for
the first time a few months later from a friend, not from
the endodontist. I do think the endodontist had a
responsibility to present this option. So I currently plan
to dump him.

I scheduled an appointment with the endodontist on Feb. 14,
to try to get a decision from him and see if he has anything
intelligent to say about implants. When he prescribed the
amoxicillin last month, he spoke of how we might prescribe
this periodically to keep the infection 'under control.' Now
I think he may have been sort of trying to put off the
inevitable and keep me happy with the apicoectomy.
Infections don't just go away with penicillin and the like,
right? They have to be cut out, generally speaking, or maybe
opened up and thoroughly irrigated (speaking of flesh
infections), right?

OTOH, he'd be a fool to routinely perform molar
apicoectomies that he thinks are likely to fail. Maybe he's
just clueless and inexperienced about success rates.

I am a little concerned that my dentist is hesitant to
criticize the endodontist's work, due to their being members
of the great fraternity. But darn it, I have a new lease on
life due to other things going on here, and I sure as heck
hate postponing the inevitable and wasting all this time
with the apicoectomy. My mouth is a bit foul (bad sign, I
know), too, and dammit, I need good breath(!) for my love
life. I am thinking I want this darn tooth out. I want to
say goodbye to one of the last remnants of my teeth grinding
days (long hours at work, which led to an early retirement,
for good or bad), and let the several month implant process
commence.

Isn't the point of a bridge or implant to keep the
surrounding teeth from caving into the empty socket? So no,
I am not understanding your last two statements above.

Right. Thank you.

    I'm sorry, but while I have no difficulty agreeing with the substance
of much that you say, but I am concerned about the tone and the
implication of your post.
    First of all, there is no way you can tell if this tooth is hopeless.
Given the history I wouldn't be surprised at all that (were I to examine
this patient) I might well reach the same conclusion.
    If you are a restorative dentist please accept my apologies.  You are
charged (as I am) with restoring the patient to function and appropriate
esthetics, and will naturally want a predictable result from the
specialist that allows you to do the job your patients deserve.
    If you are an oral surgeon, I believe you owe our endodontist
colleagues an apology.  There is no way to suppose that endodontists
will think about implants the way surgeons (or indeed restorative
dentists) will.  Still, good endodontists will evaluate a case on its
individual merits--including  periodontal and restorative
considerations, and will not advise treatment for teeth with a poor
endodontic, periodontal or restorative prognosis.  I know that my
specialists will often call to discuss restorative plans for a patient
before beginning treatment.  One reason is to make sure we're on the
same page in terms of the viability of a tooth.
    Most of the surgeons I work with likewise will discuss the prognosis of
teeth where there are endodontic, periodontal and restorative questions
(as well as occasional surgical considerations that may have slipped my
mind).
    There is no question that implants are perhaps the most important
restorative modality to enter the mainstream of dental practice in the
past 50-100 years.  It is understandable to me that all dentists see an
exciting new technology and jump on it--sometimes too enthusiastically.
 I have had surgeons recommend removal of perfectly restorable teeth
and implant prosthetics.  Disappointingly to me, this is occasionally
done without speaking to the restorative dentist (that's  ME, Jackson!)
beforehand.  This has led to very unpleasant situations when the patient
returns eventually to my office, where I find implants in situations
that make it very difficult for me to carry out a treatment plan on a
patient in a way that I believe works best.
    I am particularly concerned about the apparent impression that some
patients have apparently gotten (from the media perhaps, but perhaps
surgeons), that implants have near a 100% long-term success rate.  While
most of my implant patients have indeed enjoyed good success over a
significant length of time, this is still a relatively new technology,
and things may well look somewhat differently in 20 years or so.  At the
present time, I feel it necessary to point out that there is no clinical
procedure that is 100% successful--even those performed by the very
highly-skilled OMF surgeons and periodontists I choose to work with.
    My position is that each clinical situation is different, and must be
evaluated on its individual merits.  A tooth which has failed
conventional endodontics and apicoectomy is a 2-time loser, and may well
be a good candidate for a different approach.  However, some of the new
bromides I hear, such as "an implant will last 30 years at least, but a
fixed bridge only lasts 10 years" ain't the kind of discourse that I
think does the patient (or us!) any great favors, and implying that
endodontists are closed-minded because you "won't get your 1K back for a
failed endo" isn't going to get the best treatment for our patients.

Steve

I was wondering about this. The front desk person did not
seem concerned the other day when I said I really wanted the
tooth out, and could that be done in the same visit if the
doc agreed.

I agree I should double check on whether I should be on
anti-bs for awhile.

Oh yes, no doubt.

Understood. I just figure the narcs(?) are the best medical
science has to minimize severe pain, so why not use them?
Per an experience last summer, though, and as you and the
others here may know, some in dental health hesitate to
prescribe the best due to concerns about addiction.

Geez I hate having to sort of plead my case, "I am not an
addict!" Just give me a two days' supply, for this bona fide
extraction needed due to an obvious infection, and if I come
back asking for more, then get tough. It sucks being in
dental pain. It's somewhat depressing. A few bad apples (re
getting prescriptions for narcs) mess things up for the rest
of us?

Thanks for the input, Steven Bornfeld.

For a definitive answer, by all means consult your treating
professional (and they might not know for sure until after
the tooth is out).

However, IME (27 years and thousands of extractions) one
*normal* extraction on a *healthy* patient is usually no big
deal.

D