Periapical inflammation

[Angel6809]

What exactly is "periapical inflammation" and on average how long does it take to subside after the first stage of a root canal on an upper central incisor?

[Jerome Tsang, DDS]

Okay.  Well, if he feels that a re-treatment won't work, then yes, an apicoectomy is necessary.  A re-treatment would be to do a root canal over again and if he isn't able to clean it properly all the way down, there's no point in trying to do it again.  I can't really speak for him in terms of anticipating problems with the root canal.  He's a specialist and has more advanced training so I'd assume it was more difficult than normal and that's why he was recommended to do it.

[Angel6809]

The endodontist has told me that because my roots are so long that he doesn't think he can reach the end of it properly.  However I thought that's what endodontists specialized in.....getting to the end of canals that ordinary dentists couldn't reach.  And I also thought that when he did the first stage back in November he would have been able to see everything with all his microscopic equipment as he was working.....he only told me the information about the apicoectomy right before Christmas after I had been in pain for so long.  Surely he would have had an inkling before he finished the appointment in November that he couldn't reach the tip of the root?  He's told me the apicoectomy will have to be done and then he will go ahead and finish the root canal, but he hasn't mentioned trying to redo the first stage again.

[Jerome Tsang, DDS]

I don't do apicoectomies.  From my understanding though, they probably have approximately a 70% success rate.  I'm wondering why the endodontist doesn't attempt the root canal again though.  I'm not saying he/she is wrong but I would imagine that a retreat of the canal may be done first prior to an apicoectomy.  It may be that the endodontist feels there's some unusual anatomy at the root end and that a regular root canal can't fix it so an apicoectomy is needed.  

[Angel6809]

Hi Jerome.  Yes he put me on antiobiotics and pain medication.  I stopped taking the antiobiotics almost 2 weeks ago because I had been taking them every day since November 17th  when the procedure was done.  He recommended that I see an oral surgeon to have an apicoectomy done on the root end.  However I'm really quite nervous about this procedure and not sure if it will even help.  In your experience do they work?

[Jerome Tsang, DDS]

Its possible that some leftover nerve tissue can cause problems.  Has your endodontist given you antibiotics or pain medications?  Your endodontist may need to do the root canal again to make sure its all cleaned out.  Otherwise, its possible there may be a fracture somewhere on the tooth.

[Angel6809]

Thank you Jerome.  My problem is very perplexing.  I had the nerve removed from my upper central incisor 7 weeks ago and the tooth has been causing me a LOT of pain ever since then.   As soon as the novacaine wore off I was in excruciating pain.  (The entire root canal is not finished as yet and the tooth has medication in it).  The endontist had assured me over the past 7 weeks that there is definitely no nerve left in the tooth to be able to cause this amount of pain.  I can't bite anything with this tooth yet.....can't put any pressure on it whatsoever without it hurting, not even a cotton wool roll.  I'm so upset because I'm frightened I will lose this tooth and it's my front one.   My question is that if the endodontist was not able to reach to the very tip of the root when he first cleaned out the nerve, could there still be nerve fiber or tissue at the tip that has caused all this pain?

[Jerome Tsang, DDS]

If there's periapical inflammation (or what I call apical periodontitis), it probably won't really resolve until the root canal is finished and the area can heal.  Afterwards, it can take upwards to about 4 weeks to heal although I think for the most part, a week or two would be more likely.