RCT failure, wait vs apiceotomy, or maybe dental implant? (Photo)

This one is easy.  A dental implant is a much better long term solution than having an apicoectomy.  Once the implant has healed and been restored with a crown you should not have to worry about the area anymore. Good luck.  

I would never leave a failing RCT to chance and take serial antibiotics when a flair up begins.  You will likely have recurrent exacerbations of pain followed by periods where nothing bothers you.  The question is, is it worth living like that?  Imagine if you were on a vacation out of country somewhere, Paris, Maldives etc and you had a tooth ache ruin the trip. Analyzing the data you have presented, I would at some point have the tooth removed with a bone graft to maintain the integrity of the bone architecture, followed by a dental implant.  The success rate of implants is very high when done by an implant specialist such as an oral and maxillofacial surgeon or a periodontist.  I know some great surgeons in New York if you need some suggestions!  All the best!

u have two options. if u want to save this tooth, in that re rct is ideal option. CT scan will give clear idea. and now , if u r fed up with RCT thn go for implant.

Hi:Unfortunately with root canal infection the infection will not go away with antibiotic in the long term.  The source of the infection has to be treated in order to make sure the infection goes away. If the tooth is not cracked,  Apicoectomy might be your best option at this point.Best,Dr. Maddahi

It would be great if your endodontist utilized a CBCT scan and if they did what did they find that was untreated or was a potential crack found.  They most likely "scoped" the internal of the tooth as well.Apico's have AT BEST a 50/50 chance of success in my experience.The last thing I would do is, if possible, remove ALL the root canal filling and place 3-Mix MP or some other antibiotic-like paste into the canals and leave it alone.  If it goes back to normal.....after 6-12 months of happiness, I would fill with a bio-ceramic material.This tooth will always have a guarded prognosis, if it is a stress crack in the root, nothing will work for very long and thus removal, then either 1) osseous graft/membrane/implant/abutment/implant crown or 2) 3-unit bridge as the adjacent teeth seem to have large fillings which usually means weaker supporting tooth structure.  Has the tooth in front of this had endodontic treatment?  It looks unusual and may have a "radiolucency" and should have vitality testing.

Hello, 
Taking in account you have already done twice the root canal treatment and none of the doctors seem to find the source of the infection, a more secure and permanent treatment would be implant. Apicoectomy might not work if the original source of infection is not found, and you seem to have enough bone for implant. 
Dr. Franco