Molar tooth root amputation or redo apicoectomy done 10 yrs. ago

[expertise]

I recently developed an abcess on my top right molar tooth 2nd from the back.  This tooth had undergone a root canal & w/i 6 mths. an apicoectomy which was about 10 yrs. ago.  The dentist I saw yesterday recommended an amputation of the one root or see an oral surgeon who can a dental implant. He said there was no guarantee that the other two roots would hold up & that food & bacteria might collect in the tooth after the amputation.  My question is which procedure is less invasive: the amputation of the one root or extracting the tooth & having an implant put in.  Also, can a redo of the apicoectomy be done instead of removing the entire root?  Scheduled for this amputation procedure, but not sure if it's the best thing to do.  Please help!

[Chitshakti]

hi,
the best thing u can do is get the tooth extracted n go for an implant....getting apicectomy done again might not be successful...the best option is an Implant.

[mac4470]

I have had 2 apicoectomies,now I am having a root amputation and am terr to fight terrified. They put me on antibiotics for 2 weeks to fightthe infection. They said I am not a candidate for extraction and implant because I am diabetic.Please anyone else with these problems,let me know.

[Hazer]

I just had a root amputation done.  Afterward I read that:

"I have sometimes seen root amputations performed without doing a retropreparation and retrofill. That would be the same as doing a root canal without placing a permanent restoration. Bacteria will leak in and contaminate the root canal".

What exactly is a a retropreparation and retrofill?

[scottma]

The gap between gum and tooth is easily cleaned by interproximal brush or superfloss. The choice of tool depends on patient's preference. The amputated tooth is not really more vulnarable to decay than other teeth. Periodic visual or x-ray exam can generally detect decay.

[expertise]

After this root amputation was performed I had mild cheek swelling & no serious discomfort.  However, its now 1 week later & I have a large gap at the top of the tooth where the gum meets.  Is this normal?  And does this gap not lead to possibility of decay to the other roots. How long before serious decay can set in?  Is there any way to rectify this.  If teeth are vulnerable to decay in general, what does that mean for a tooth which now has a gap at the top near the gumline.  If I run my tongue above the gumline where the procedure was done, it feels different than the other side.  It caves in on the gumline as well & behind there I can feel the other two roots.  PLEASE HELP?

I'm 48 yrs. old, wanted to save tooth, but not have a high maintenance situation where it's just inevitable that this tooth is extra vulnerable & left exposed to decay because of this gap in tooth.

Thank you very much.  

[scottma]

it's mandatory to submit the specimen for microscopic exam to rule out malignancy. 99% of the microscopic exam will yield a diagnosis of periapical granuloma or apical periodontal cyst.

[expertise]

Had the root amputation this morning.  Had ice packs on cheek all day to help prevent any swelling.  Have prescription for vicodone just in case.  Apparently, the dentist said that root did have a crack in it & that there was not enough root to redo the apicoectomy so an amputation was necessary.  He also took a biopsy of the area where there was a black shadow on the xray (above that root).   The abcess was above that tooth.  Is that a normal procedure to take a biopsy?

Thanks!

[expertise]

THIANK YOU VERY MUCH!  I am more at ease with going to my appt. this morning. You've been a blessing!  I appreciate your taking the time to reply.

Have a great day!

[scottma]

Dear expertise:
       The rationale I approach is : periapical lesion develops after root canal treatment, (which is rare), redo rct. If periapical lesion does'nt resolve after redo rct, periapical surgery( apicoectomy and retrograde filling),  if periapical lesion persists after periapical surgery, root amputation is performed. This approach assumes only one root is involved. If mutiple roots are involved, extraction is indicated. If two health roots are preserved, the tooth can function well for many years.It appears that you had rct redo and periapical surgery already, if you were my patient, I would do root amputation.
      Root amputation is generally not associated with post-op pain. However, cheek swelling is commonly encountered. If you are concerned about post-op pain, premedication with antibiotics and NSAID are helpful. The regimen I give to my patient is: 2gram amoxicillin and 100-150 flurbiprofen one hour before procedure. Post-op antibiotics is dispensed as regular prescription. if you are allergic to penicillin, other antibiocs are indicated. I personnally prefer clindamycin as alternative to penicillin allergy patient. However, the regimen really depends on your private dentists. I am sure he/she can take good care of you. Root amputation is a minor oral surgical procedure, if you don't have compromised medical condition, post-op condition is generally uneventful. Good luck
regards

[expertise]

Thanks for your reply.  Have an appt. tomorrow am for either a redo of the apicoectomy or the root amputation.  Are there any questions I should ask the dentist before he performs surgery.  What should he look for to decide whether it's a redo apicoectomy or a root amputation?

What kind of post surgery pain might there be and is it any more than the pain associated with a regular apicoectomy.  What type of pain meds work the best.  

[scottma]

Dear expertise:
      Root amputation is the better option. If the other two roots are periodontally healthy, the tooth can still function many years.