Does a Tooth Abscess Require an Apicoectomy?

I’ve had a chronic abscess above my top right second molar. My dentist has watched the abscess to ensure it doesn’t grow or cause discomfort. Two weeks ago, my dentist surprised me and recommended that I see an endodontist for a root canal. The endodontist recommended an apicoectomy to ensure I do not have an abscess. I read about the procedure, and I think it’s too aggressive. Is there an alternative to the apicoectomy? What if it’s not a cyst? Thanks. Hannah from NM

Hannah,

Although dental schools teach dentists about cysts and the complications they can cause, most dentists rarely see true cysts in everyday practice. Some dentists also tend to magnify the risks so patients understand the risks and the dentist is protected if complications arise.

Is This Swelling Likely a Cyst?

Swelling could involve a cyst, but the odds are relatively low. In most cases, swelling comes from a chronic dental infection. Root canal therapy is usually the more conservative and appropriate first step. An apicoectomy seems unnecessary at this stage.

Why Treat the Infection?

An ongoing abscess allows bacteria to enter your bloodstream repeatedly. Even when an infection does not cause severe pain, it can still affect your overall health and energy level.

After the root canal treatment, you may begin to feel better overall. Chronic dental infections often cause fatigue.

Is Root Canal Treatment Worth It?

In general, root canal treatment has a success rate of at least 85 percent. When an experienced dentist or endodontist uses modern technology and techniques, the success rate is often considerably higher.

Even if the root canal does not heal completely, you still have additional options later. At that point, your dentist or endodontist could consider the apicoectomy they mentioned. Starting with the more conservative treatment first usually makes sense.

Dr. Thaddeus Michalski, a Rocky Hill, Connecticut dentist, sponsors this post. Read why many of his patients say he is one of the best dentists in town.

Will I Regret Not Getting a Tooth Extraction and Dental Implant?

I had a root canal in 2020 without any problems until now. The tooth has hurt on and off for the past month, but now it’s starting to throb. I am afraid that I will need an extraction. Is it worth repeating a root canal, or would I regret not getting an extraction and a dental implant? – Thanks. Elias

 

Elias

Root canal failure can be frustrating and painful. It happens when a tooth doesn’t heal completely after a root canal treatment, leading to recurring symptoms. Your symptoms may be the result of root canal failure.

What Causes Root Canal Failure?

A hidden tooth infection or curvy tooth roots can contribute to root canal failure:

• Hidden infection: It can be challenging for a dentist to remove all the infection from a tooth’s complex root canals. Even a tiny amount of remaining bacteria can cause problems later.
• Curved or branching roots: These can make it hard to reach and clean all areas of the tooth.

What Are the Treatment Options for Root Canal Failure?

The treatment options for root canal failure are retreatment, root canal surgery, or extraction and a dental implant for an unsavable tooth.

• Retreatment: A dentist can attempt to clean the infected area and seal it again.
• Root canal surgery: A dentist or specialist must access the tip of a tooth near the gumline and through the bone to remove the infection. An endodontist (root canal specialist) typically performs this procedure (apicoectomy).
• Extraction for tooth fracture or an unsavable tooth: A crack in the tooth can also lead to pain and infection. Unfortunately, saving a tooth with a severe fracture can be challenging.

See a dentist with extensive root canal treatment experience or an endodontist to discuss your options.

Dr. Thaddeus Michalski, a Rocky Hill, Connecticut dentist sponsors this post.