Got an apicoectomy on lateral incisor 4 years ago due to a big apical abcess. Initial cause still unknown, supposing it's teeth grinding during the night that might cause the tooth's pulp death. First apicoectomy failed, maybe bad root canal work or residual bacterias, infection is back. Should I go for another apicoectomy to try to save the tooth or expand its life with several years? Or should I go for an extraction and implant? Note the bone loss from CT and the length of remaining root.
October 2, 2017
Answer: Second Apicoectomy In my experience, I have not seen very many second apicoectomies that have lasted very long. I have removed many teeth with failed apicos. With the high predictability of dental implants, I would personally have the tooth removed, a bone graft to fill the large defect from the failed apico, and a future dental implant.
Helpful 1 person found this helpful
October 2, 2017
Answer: Second Apicoectomy In my experience, I have not seen very many second apicoectomies that have lasted very long. I have removed many teeth with failed apicos. With the high predictability of dental implants, I would personally have the tooth removed, a bone graft to fill the large defect from the failed apico, and a future dental implant.
Helpful 1 person found this helpful
October 2, 2017
Answer: I would recommend removing the tooth Hello. Thank you for your question. As dentists we oftentimes try really hard to save teeth. Experience teaches us that there are times when it's better to remove the tooth. After reviewing your CT scan images, it looks like the bony defect is just too much. The most important determinant for success is how completely the underlying infection can be removed. The best way to do that in this case is to remove the tooth. With good ridge preservation at the time of removal you will have the option to restore with either a bridge or an implant. Don't decide right now. If the bone height after healing is optimal then definitely go with the implant. If the resulting bone height is too high then consider a second graft or just go straight to a bridge. It is going to take a bit longer to complete treatment but the long term prognosis is going to be way better. Hope this helps. Best of luck.
Helpful 1 person found this helpful
October 2, 2017
Answer: I would recommend removing the tooth Hello. Thank you for your question. As dentists we oftentimes try really hard to save teeth. Experience teaches us that there are times when it's better to remove the tooth. After reviewing your CT scan images, it looks like the bony defect is just too much. The most important determinant for success is how completely the underlying infection can be removed. The best way to do that in this case is to remove the tooth. With good ridge preservation at the time of removal you will have the option to restore with either a bridge or an implant. Don't decide right now. If the bone height after healing is optimal then definitely go with the implant. If the resulting bone height is too high then consider a second graft or just go straight to a bridge. It is going to take a bit longer to complete treatment but the long term prognosis is going to be way better. Hope this helps. Best of luck.
Helpful 1 person found this helpful
