Root Canal Apicoectomy Failure – Relation to Dental Implants (Ramsey Amin DDS – Burbank, California)

If you have a root canal and now need a dental implant there are some very important issues to be aware of.  This is especially important if the tooth to be extracted is in the upper front area. It will have consequences on the final result and cosmetic appearance of the implant.

A previous failed root canal can be a major detriment to having an implant.  The problem is related to a hole that develops in your bone which dissolves the very thin outer wall of bone.

Although root canals work, they are not 100% effective. Some teeth may not respond as expected to the root canal therapy.  Sometimes, it is clear from the beginning that the root canal is not working as planned. Other times, it may be years later that a problem arises.

The problem is usually re-infection of the root canal or a broken, fractured root. This usually shows up as a painful pimple on your gums.

Often times a root canal is “re-done” if the root becomes re-infected.  I have seen patients that have had the same root canal done 2-5 times before finally


extracting the tooth and having a dental implant!

The infection causes bone loss to occur around the root where you would need bone for a dental implant.

An apicoectomy, or “reverse root canal,” is sometimes done as a last ditch effort to save an almost hopeless tooth with a root canal.  It does not have a very high long-term documented success rate.  You have about a 40% chance of losing the tooth in 5 years.

The Procedure: Surgical access is made through the bone, and the tip or apex of the root can then usually be seen through this “window” in the bone. The tip of the root is cut off, and a sealing filling is placed at the end of the root.

Examples:

X52865X52374 
  
That is where the problem occurs.  The hole made in the bone to do the procedure does not always heal leaving a defect under your nose if it is in the upper front.

This CT scan image of my patient that I treated in my office in Burbank shows this exactly:

X52865_1 X52865_2 
Although, this hole is correctable, it usually requires a more extensive bone graft to correct.  This increases the cost and time to have the dental implant. 

The worst case scenario is where the “apico” fails and the entire outer bone wall is lost. This usually requires and onlay block type bone graft taken from your chin or the side of your jaw to correct.

My recommendations…look at all your options and plan for the long-term.  Saving a hopeless tooth may in fact be more problematic and costly than extracting and maybe having a same day immediate implant.

Please feel free to comment or ask questions in the comments section below.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

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120 Responses to Root Canal Apicoectomy Failure – Relation to Dental Implants (Ramsey Amin DDS – Burbank, California)

  1. John R. says:

    That’s really interesting. Thanks for the info.

  2. Kristina Rudzka says:

    Hi,
    Can I please ask a question.
    Ive had a Apicoectomy 10 weeks ago, i go to the cons in november to findout if it worked, but would i know now really if it worked? if i had pain?
    Also if i needed to have my tooth taken out(front) how long do i need to wait till i can have a bridge?
    Thank you lots

  3. Hi Kristina,
    Generally an x-ray will be taken several months later to check the healing. The dentist will check the gums in the area also. A failed apicoectomy may not have pain so give it some time.
    If you need to remove the tooth, a same day temporary bridge can be made. You will wear that for a few weeks, then the final molds can be made for the real bridge or implant crown.

  4. Gola says:

    Hello Dr. Amin: My top front tooth ‘died’ over 30 years ago. The tooth was bleached 2x and eventually I had root canal work, post and crown, all which lasted many years. Most recently the tooth became loose and fell out. One dentist said the work on the root canal did not go deep enough making the post too short and not as strong as it could have been. I am having conflicting information regarding a new root canal. One dentist said I do not need a new root canal as the tooth already had one. Would you recommend I re-do the root canal, post and crown or should I think about an implant?
    Thank you for your time and consideration,
    Margaret

  5. Hi Margaret,
    30 years is a excellent life span for a dead tooth!
    Retreating the root canal vs. a dental implant is a difficult decision sometimes.
    It depends how much of your original tooth is still present to hold a new crown and how healthy the root is.
    Without seeing you and an x-ray, I can’t give you an educated response.
    Consider seeing an endodontist for an opinion.
    I hope this helps! Let me know if you need anything else!
    Respectfully,
    Dr. Amin

  6. Emily says:

    Hello, I came across this in a google search- I just had my first root canal done (it’s my right lateral incisor), and I’m only 25. I went in for my first checkup on it today, and my endodontist told me that it doesn’t seem like it’s healing well (it’s “very stable” he said, but the bone isn’t healing as much as he’d like, and I’ve also had NO pain, swelling, or infection since it was done). He told me to come back in 9 months (a year from when it was done), and if it still hasn’t healed better then I will need a bone graft… is there any other way to take care of it? A bone graft sounds pretty serious. Or is there anything I can do to make my bone “heal better?” I have no clue what to do. Thank you!

  7. Hi Emily,
    Don’t fret just yet. Most root canals that are well done, heal great. They need a lot of time to heal though. Lateral incisors usually heal really well with complete bone fill. Give it about a year.
    It’s the molars that cause the biggest issues! It should be fine!
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry
    Website ~ http://www.burbankdentalimplants.com
    Blog ~ http://www.dentalimplantdentistryblog.com
    818-846-3203 — Burbank, California

  8. Henry says:

    I had a apicoectomy done to me about 5 wek ago because of tooth infection didn’t go away. It’s have been 5 weeks and after I stoped taking the antibiotis my upper lip began to swollen and the right side of my nose. I’m going to see the the dentist Tuesday. Is s the extraction of the tooth wiil help to get rid off the infection.
    Thank you!

  9. Hi Henry,
    What did your dentist say at your appointment on Tuesday?
    Dr. Amin

  10. Aleta Peterson says:

    I have been told I have to have a root canal on #19. I am also experiencing pain below my jaw and into my neck could this be from the bad tooth?

  11. It is very possible! Yes!

  12. carina says:

    Hello Dr Amin,
    I just had an apicoectomy, about 20 days ago. I do not have any pain and the tooth feels good, but a pimple developed right after my stitches were removed, about two weeks ago. I took antibiotics for a couple of days and the pimple went away, but now is back. Its not necessarily painful, I can eat normally, but I am afraid about what this may be.
    Thank you in advance.

  13. Hi Carina,
    It is possible that there is a problem. I would see your dentist asap.
    Dr. Ramsey Amin
    Burbank Dental Implant Dentist
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry
    Website ~ http://www.burbankdentalimplants.com
    Visit My Blog ~ http://www.dentalimplantdentistryblog.com
    818-846-3203

  14. Diane DeCosta says:

    I had an epicoectomy done to a tooth on the lower right quadrin, not the eye tooth, but the one after that located toward the back, but is not a molar back in 2002/03.
    Over the past year, that tooth has been sensitive, and mildly painful. In the past year, twice I’ve had swelling on the outside of the jawline about the size of an egg,thus swelling on the face. It’s painful, I can’t chew on that side….eventually the swelling goes down. I’ve had no insurance for 2 1/2 years…..I don’t want to wait until an emergency happens……what do you think.
    Sincerely,
    Diane

  15. Hi Diane,
    Consider seeing an endodontist for an opinion asap.
    It could even be another tooth!
    Dont wait on this.
    Respectfully,
    Dr. Amin

  16. Emerson says:

    I have had an crown chipped in back of my mouth on top of root canal, I need to know as far as cost efficient, should I just get an implant vs redo of an root canal and crown

  17. Hi Emerson,
    Re-doing a root canal should be carefully determined by a dentist. There is no way for me to tell you this based on your question alone. You must be examined.

  18. Colleen says:

    Hi Dr Amin:
    After an accident, I had 4 root canals performed on my upper front teeth. This was 4.5 years ago. About 3 weeks ago my palate behind one of my front teeth felt sore… nothing unbearable but i was aware of tenderness. today i’ve got a bump on the palate edged up behind my tooth. could this be a failed root canal so many years later? i’m terrified i’ve let something go (even though my symptoms are very recent) and i’ll lose my tooth (oh and i’m still paying off my veneers!). thank you for any information. it will ease my mind.

  19. Hi Colleen,
    Sorry for the delay in my reply.
    Yes, the bump behind the tooth you mention may be a failure or it may be a localized gum problem.
    Get to a good dentist asap!
    :)
    Dr. Amin

  20. Alicia says:

    I have a question, I’m 26 years old, I had two root canals and two crowns put on my two front teeth when i was 14 due to a fall that happened. Well, I just went to the dentist and they told me i need a root canal and a apicoectomy and a bone graph. The tooth that needs the root canal is the anterior tooth to the right on my front tooth. My question is, Should i have this done, and have implants done or should i try this and hope for the best? I’m so scared and lost as to why this has occured. I’m young and have two young children ,this is so not fair :(

  21. Hi Alicia,
    Without seeing you, I could not tell you exactly. Ask your dentist what they would do in their own mouth.
    Ask what is the long-term prognosis of your particular teeth.
    Ask if they feel implants may be better.
    Good Luck,
    Dr. Amin

  22. Jami Wirl says:

    I have had two different crowns, then two root canals on a lower middle tooth. Lastly, I needed an apicoectomy done because the dentist left a piece of the drill bit in the root canal which became infected and formed a cyst. Now, a year and a half later, I have intense swelling in the gum. I have been advised to take antibiotics and go in Monday for x-rays to see what my options are. Do you have any foresight or recommendations for me?

  23. Caleb says:

    Hi, Today I had my front #10 tooth extracted in preparation for an implant after the tooth became reinfected (it was previously root-canaled a dozen years ago).
    Upon extraction today, my oral surgeon said I’ve lost a lot of bone from the infection and that the chances for implant success are now low — he still used an artificial graft material — but said he thinks I will mostly likely need a bridge.
    After reading through your posts today I feel like he is not giving me full options on other means by which to build up the bone for an implant. Are there other grafting options you can suggest for me to ask him or another surgeon about?
    I am a healthy 33 year-old, non-smoker, with no other dental or bone issues past or present.
    Thank you

  24. Hi Caleb,
    Tooth #10 area is generally easy and sucessful to rebuild. I usally do block onlay grafting or GBR (guided bone regeneration)in my practice in Burbank to get the best outcomes.
    What is going on with the teeth right next to #10? Any crowns or bone loss?
    Ramsey A. Amin, D.D.S., D.A.B.O.I.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry

  25. Mithilla says:

    Hi Dr,

    I m in NJ.
    Is there an email id i can drop you a mail at? As i would like to send you my x-rays while i explain you the state of my tooth. Please do reply to the email id provided herewith.

    – Mohana M

    • Hi Mohana,

      I would need to see you in person to do a full evaluation. X-rays alone does not give me enough information to help you properly.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      818-846-3203

  26. orrie says:

    I have a tooth that was root canalled a long time ago.
    last december i had an apicoectomy on the tooth.
    the infection returned, so this past july the oral surgeon performed another apicoectomy. the infection has again returned.

    i want desparately to save the tooth, if possible.
    may a root canal be performed after an apicoectomy?
    should i have seen an endodontist, rather than an oral surgeon for the apicoectomy?

    thank you.

  27. orrie says:

    i also wanted to mention that the abscess gets larger when i eat and drink,
    and decreases in size if i avoid eating and drinking.

  28. orrie says:

    I failed to mention that the abscess gets bigger when I eat and drink and smaller when i dont.
    i asked the surgeon why, but he said he didnt know.

    • Hi Orrie,

      After an apicoectomy, the tooth should be doing ok “IF” it works. You may lose the tooth and end up needing an implant in the very near future. If so, some degree of bone grafting will probably be needed too.
      Respecfully,

      Dr. Amin

  29. Jen says:

    Hi Dr. Amin,

    I went in for a root canal (on #23) that was not able to be completed due to calcification near the root of the tooth. There has been some bone loss but the tooth is still stable and shows no signs of deep pockets around the gum line. I have been told that the next step would be to do an Apicoectomy with a bone graft (osteo graf) in the attempt to try to save the tooth but that there is no way to tell whether it can be performed/completed until the gums are pulled back (from eye tooth, to eye tooth).

    I’m not really questioning the Apicoectomy at this point after reading up on what it is for, but about the fact that the need for the gums from the eye tooth, to the other eye tooth needs to be pulled back — For one tooth, does that much truly need to be removed, in order to get to the root of the #23 tooth?

    Thank you for having this site and being willing to help all of us who are having to make such difficult decisions on what to do!

    • Hi Jen,

      Sometimes in order to access even one tooth, the incision has to be as long as six teeth. It is important that the dentist can access and see the area very well before doing anything.

      That being said, there are different surgical approaches that vary by the dentist’s their training, judgment and experience.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  30. maria says:

    Hello Dr. Amin,

    If an apicoectomy can possibly fail, will an extraction and implant be more practical (i.e. less expensive in the long run; faster healing process)?

    What possible dental problems will occur if two front teeth are extracted?

    I will appreciate a quick reply. Thanks.

    • Hi Maria,

      Your situation is a tough one to say without seeing you and your x-rays. Either way there may be some degree of compromise. Both options will have their own unique risks, benefits and alternatives.

      Work with a great dentist in your area to guide you on making this decision.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  31. Tammy says:

    I need to make a quick decision. The right side of my face has been swollen for about 4-5 days…now finally subsiding after cross-treating antibiotics. It’s been recommended I get an apio on #4… because the post in my root canal is too big to drill without cracking the tooth/crown (the tooth was originally a cracked tooth from chewing ice). The dentist mentioned there is movement in the crown/loose tooth and he thought he saw a crack in the xray, but the endo said he doesn’t remember noticing any movement and he said he did not see a crack? Within the month, I slipped and fell down and my teeth were very sensitive that day (felt weird when sipping soda) and the following week my left jaw a couple times became numb, tingly, and painful. I saw an ortho who thought it was possible from a scan that I had a slight fracture in my jaw, but the oral surgeon follow up on a 360 showed no fracture, but a problem with #4. No pain or cyst showed up until a couple weeks later and the swelling didn’t show up until the dentist tried to see with a pick if he could help and then sanded my tooth some to prevent it from hitting the bottom tooth to help the pain. I read about bacteria leaking from teeth of root canals and the potential for health issues, but I don’t welcome the idea of another tooth being pulled either…especially because an implant would be much more expensive, and then couldn’t that get infected too or harbor bacteria? I don’t know what to do…now I read about bone loss from your site, and that wasn’t even an issue I knew about…I certainly don’t want to lose any bone. I’ve been told the first root canal was not done properly, but I think based on the sequence that the tooth or post may have become loosened when my teeth banged when I slipped and fell and then bacteria entered and became infected or whatever was happening there already got jolted and turned into an infection? I’m also wondering if I get the apio…—if the tooth/crown is already loosened, would that immediately allow more bacteria to enter and become infected or wouldn’t it matter because it would be closed off with filler? Sorry for all the questions, but I have to make a decision in the next 2 days. Thank you for offering to help with your opinion.

    • Hi Tammy,

      It really comes down to a question of predictablity. If the endodontist feels that the tooth has a good long-term prognosis with the apico then by all means save the tooth. You must make certain that the remaining tooth structure is sound to hold a crown also. If both of these are in your favor, it is better to keep your tooth!
      If it is really questionable, then the obvious answer is to extract and place a dental implant even though the cost will be more.
      Good luck and keep me posted!

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  32. Jay says:

    Hello Dr. Amin,

    A recently had a dentist’s visit and he said my tooth#19 had cavities some time ago and was left untreated. Now it was spread a lot more and recommends I do a root canal. I am currently not in any sort of pain, and he says this is early on and we can try and save the tooth; he recommeneds a location which has less than 2% failure rates with Root Canals and he has been working with them for over 20 years (these are endodontists)

    I have had previous root canals done to my tooths #5 and #12 about 7 years and ago and both of them failed in the last 2 years one after the other. I had them extracted and put in implants. One implant is complete while I am still on the healing process for the crown on the other one.
    I am not sure if I need to try and save my current tooth #19 molar – do a root canal and then crown and then have the risk of having that fail too, hence I am debating whether to have it extracted and implanted like the others. Given the nature of the tooth (being molar) and having multiple roots; the RC procedure is going to more complicated than tooth with a single root. The dentist said the infection is not too bad and we can save the tooth now; but I never understand the concept of “saving a tooth” esp after RC when the tooth is dead and having a crown put on it. Why would it not be wise for me to rather have it extracted and implanted?
    Given the location of the tooth and the complications with bone loss during extraction or with RC procdure and considering my dental past of 2 RC failures, what would you suggest be the better route for this situtation? Extract and implant or RC, crown and having the risk (if at all) of the RC failing? (appt in next 3 days)

    Thanks a lot!

    • Hi Jay,

      Sorry I couldnt get back to you within your time frame. Without seeing your mouth and x-rays I couldnt guide you on exactly what to do.

      In my own mouth, if the tooth or teeth were predictably savable with root canals, that is what I would do. Dental implants are great, but if your own tooth is healthy enough to save, that is the best.

      Make sure you get the crown and root canal done by a high level dentist. Trying to get it done cheaply will only cost you more later.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  33. Cheryl says:

    Had a root canal on #7 almost 4 weeks ago by a dentist. Symptoms after root canal: tooth hurt when tapped or pushed on, also throbbed when walking/running. Saw endodontist after 2 1/2 weeks who prescribed steroids and antibiotics. Took all meds but symptoms unchanged. Endo says tooth looks good on x-ray and wants to see how tooth is doing in 2 more weeks. I think my tooth is fractured because I had intense pain during root canal when dental assistant placed a subtance in my tooth near end of procedure which was to lighten my tooth. It felt like she pushed the substance right up into the tooth and it was very painful. I told the endodontist this but she says she doesn’t think my tooth is fractured because she sees no pimple on my gum. She also says my tooth would be hurting all the time if it was fractured. She may do another root canal. If indeed my tooth is fractured, I don’t want to have a pointless procedure. What would you do if you were me?

    • Hi Cheryl,

      Sorry to hear about your experience. If I were you, I would wait it out a bit and have your dentist continue to try to diagnose the area which may take time.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  34. Linda says:

    Hello Doctor, I have a dilemma. I had first root canal treatment 20+ years ago. I developed an abscess and had to retreat my two upper front teeth two years ago. I have developed a huge but not painful abscess again 3 weeks ago. It was finally lanced and drained last week. I was told I needed an apicoectomy. But after educating myself on internet I am lost. I have already invested so much money on these teeth, and now I am not sure what to do. Would it be better to just pull the tooth out and put an implant instead and crown on the adjacent tooth? I asked my doctor, and she thought I was crazy :o) She said its always better to try to save your own tooth, and why would I want to pull my tooth out, I can lose so much bone afterward… But then again nobody can guarantee apico will work, and it seems like I am going to lose bone with this kind of treatment anyways, right? Would an artificial bone materials help with this if if I needed to put an implant later? And what to do in case of gum recession after apico? The treatment will involve more time, money etc… That’s why I can not make up my mind, which way is better? apico or extraction :o) What kind of incision would you recommend to avoid gum recession on front upper teeth? So many questions! Thank you

    • RamseyAminDDS says:

      I suggest you have a second opinion. It really comes down to predictability over the long term. If saving the teeth is sound, predictable treatment then by all means save them. If you are only going to end up extracting them in three years then don’t waste your money. See a really good restorative dentist and an endodontist.

      Keep in mind that having a dental implant in a previous apicoectomy site is more difficult than in an area that didn’t have one. Seek out someone really good for this!

      Good luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  35. Vee says:

    Dear Dr,
    I had a front tooth root canal/crown after an injury when I was 12 years old. I remember that dentist saying I would develop an infection every 10 years or so which would require cutting open my gums and scraping out the infection.
    I am now 29 and a routine dental checkup revealed what the dentist called a periodontal abscess. The dentist prescribed antibiotics and referred me to a Periodontist. The Periodontist recommended removing my tooth and inserting a dental implant. Is this really my only option? What happened to cutting open the gum and scraping out the infection? The periodonist said he doesnt recommend it because the infection could come back. I’m terrified. It’s my front tooth. What if something goes wrong? What could go wrong? I’ve read a few things on the internet about possibly drilling into a sinus cavity? This tooth never bothered me until I took antibiotics. Now I feel a constant kind of fuzzy feeling above my tooth and in my right nostril. Should I get a second opinion?
    I appreciate your professional opinion.

    • Vee says:

      Also.. What type of dentist should I be seeing? The only specialist I went to was the referred Periodontist. Consultations run about $150-$300 for no insurance, so I want to make sure Im going to the right place. Should I be talking to a Periodontist, Endodontist, Oral Surgeon?
      Thanks again!

    • RamseyAminDDS says:

      Hi Vee,

      There are only so many times you can re-apicoectomy the same tooth. It sounds like you now have bone loss in the area and the implant is probably your best bet. If it is predictable to keep the tooth, then do so. An endodontist can help you make that decision if you think you can keep it.

      As for who to see, I am a firm believe that you will have a much better result by someone who does BOTH the surgery and makes the prosthetic tooth.

      This is especially true in the front of the mouth or complex implants. You will also save money.

      A periodontist or an oral surgeon does not do both. Find an implant dentist with at least 10 years of experience who has done a lot of implants like yours.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  36. charma says:

    I had a retreatment of rct#7 now I think it cracked it has crown. Shouls I pull it as soon as possible and also I have bone lost on the tooth vould I still get implant?#6 has impalnt also. By the way the endo thinks it has cracked and I’m getting pimple on my gum.

    • Ramsey Amin DDS says:

      Hi Charma,

      It sounds like the tooth has no hope now that it has cracked.

      If #6 is an implant already you may be able to not place an implant and rather cantilever a tooth off of it.

      It can be a great alternative to having a second implant and may even look better!!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  37. Tina D. says:

    Thank you for having this web site and answering questions. I had apicoectomy done today and only now I found out the name and more information about it.
    How is the necessity for apico determined? I had sensitivity to cold, some dull pain, moderate gum inflammation.The root canal was redone and the symptoms returned in a lesser form.The endodontist even debated that it could be the crown itself causing the problem. Could the procedure be done unnecessarily?

    • Ramsey Amin DDS says:

      Hi Tina,

      Apicoectomies are commonly redone. The rationale and decision to treat your tooth in this manner is made on a case by case basis.

      Factors include: root length, presence of a post, pocket depth, gingival bio type, medical history and many others.

      I’m sure you are in good hands. ;)

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  38. Sue says:

    Dear Dr Amin,

    My dentist referred me to an endodontist to have my upper incisor root canal redone, where I went on 6th November. And went back 6weeks after that to finish the root canal but, I still had symptoms he redone the dressing in the tooth again. I was back this week to finish the root canal finally. Luckily had no symptoms since the dresssing was done at the 2nd time, howevere when the x-ray was taken he said the infection was still there and it will need more time to show up on the x-ray if the root canal worked or not. I remember him saying in November the infection should resolve and should improvement be seen in 3months time. Now it has been 3months since I went to him and the the x-ray was the same that he took 3months ago. I am very scared to lose my tooth!! :( I am only 26yrs old! I need to go back for another x-ray in 6months. I was considering to have an apicoectomy in very near the future if the infection will still not be improving. But after having read your topic I might be better to have an implant as with apicoectomy will have some bone loss which I already have due to the infection. I just would like some advice or opinon please.?
    Also my other question would be that I went ahead with teeth whitening in the past 3weeks, before my root canal was finsihed while I only had temporary fillling placed in my tooth. The specialist said it is absolutely fine to do it. Do you think so? Is it not going to slow down the process of healing the tooth? Maybe I should have waited with the whitening or it is not an issue at all.?
    Thank you for your answer in advance!
    Sue

    • Ramsey Amin DDS says:

      Hi Sue,

      The whitening of your teeth is fine.

      I would probably give your natural tooth more time before jumping into extracting it or an apicoectomy. A dental implant is a close second to your god given teeth.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  39. Axay says:

    hi doc. i got operated for apicoectomy last week. but before 6years i have done my root canal due to cavity, so now it was infected. n done with apicoectomy. now my dentist is suggesting me for root canal. n when i asked for implant ,then he replied me ” we should first save ur original tooth. i have done this treatment to my lower grind tooth. third to visdom teeth. what do u suggest? implant or re root canal?

    • Ramsey Amin DDS says:

      Hi Axay,

      It is really impossible for me to tell you what to do without seeing you. Only save the tooth if it is predictable to do so. If it is hopeless, then extract it.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  40. Mithila says:

    Hi Chris,
    I broke my front 2 teeth(#8,#9) when i was 9 years old. I had a root canal and crowns done then and i never had any problems until Aug 2009 which was 18 years later.

    I had to replace the crowns and they found some infection (though i did not have any pain or discomfort)the doctor suggested a Re-RCT on both #8 and #9. And after 6-8 months of re-RCT when i had a checkup the doctor said #8 is not showing any recovery and we will do a apicoectomy. Though i requested him to check on #9 he said he wouldn’t touch it as its showing signs of recovery.

    In Dec 2010 after he said all is well, i had the permanent crowns done. Within few months of permanent crowns i saw the gum of #9 swollen and some pus draining out. Now he said i will have to remove the tooth as it might be fractured and he isn’t sure. As i didn’t want to loose my teeth and just want to make sure with a second opinion.

    In Aug 2011 another doctor said he would like to do an apicoectomy before suggesting anything else. So it was done on #9 and he said the infection is pretty nasty and hopefully it doesn’t reappear and sometimes it takes a couple of apicoectomy. In Dec 2011 i saw the pus drainage again. He saw my x-ray and said nothing to worry i continue to keep the area clean and rinse with warm saline water. Which i have continued to do so and also brush and floss twice daily.

    Towards end of 2012 i started seeing the gap between the tooth # 8 and #9 becoming very prominent with each passing month. #9 has started leaning/moving inwards.

    I have consulted 2 oral surgeons recently.
    1. One says a better solution will be to extract both tooth, graft, wait for 4-6 months and go ahead with an implant. Meanwhile will fix me with a flipper. Gives me no surety that implant will succeed or last for how long.
    2. Another says apicoectomy, but no guarantee of success or if the gap will increase or decrease.

    I don’t want the infection to affect the nearby good teeth and further complicate things. I know you will have to see me in person for any suggestions. But i live in Jersey City,NJ. I do have x-rays for my tooth and would appreciate your opinion in this matter. If you are willing to check, I will very happy to email it to an id you can provide me.

    Looking forward to your response.

    • Ramsey Amin DDS says:

      Hi Mithila,

      Based on what you say it sounds like both teeth should be extracted. If the teeth are moving and you have had apicioectomies in the past, retreating it is not likely to work.

      For midline symmetry, it may be best to replace both teeth.

      I would suggest you get into the hands if a dental implant expert. Preferable to have a single dentist do your whole procedure. Do your research. Front teeth are especially difficult to have long term outcomes that are perfect.
      Experience is key.

      Good luck!

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry.

      • Mithila says:

        Thanks for your response. I had both my teeth removed in Feb 2013. However i had inflammation over #9 after the removal, surgery and bone graft. The x-rays and further small incisions in the area weren’t fruitful in determining the cause of the inflammation. After 4 such successive incisions (every 2 months to allow drainage if any), in Dec 2013 i saw some relief. And have not been seeing any inflammation since.
        Currently the doctor doesn’t assure me that an implant will be a success. However he says i’m ready and implants will be the next step.
        I would like your advise on such cases if an implant will be a success and the long term of the implants. If possible also please give me a reference to any well versed implant surgeon in or near Jersey City, NJ area.

        Thanks.

        • Ramsey Amin DDS says:

          Hello Mithila,

          Go to the website http://www.ABOI.org and look for a dentist with similar credentials to mine in your area. Besides credentials, make sure that you and your Dr. get along well. You are likely to get to know each other very well!

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          • Mithila says:

            Thank you for the link. May i ask if you seen such cases as mine and if yes or no can you say what do you think is my prospects?

          • Ramsey Amin DDS says:

            without seen you, it would be impossible to know this

  41. Carol says:

    Dear Dr. Amin,
    I had an apicoectomy on tooth 24 nearly 4 years ago after a failed root canal.
    1) It was suggested that I have the tooth splinted to the 3 adjacent teeth for support. Do you know the success rate of splinting teeth after apicoectomy?
    2) Would failure of the splint mean loss of the tooth?
    3) The tooth is beginning to feel more peculiar than usual. If I need an implant and there is not enough bone, could a block graft be performed?
    4) I was told that if an implant is necessary, my oral surgeon commonly removes 2 or 3 teeth adjacent to the one in question for additional support. Why not place a single implant? The idea of removing 4 teeth is upsetting.
    Thank you in advance for your response.

    • Ramsey Amin DDS says:

      Hi Carol,

      Splinting the teeth means connecting them with bridgework or resin.

      If it is bridgework, I would avoid that due to connecting a weak tooth to the others. The resin splint is just meant to reduce mobility.

      It sounds like the tooth is pretty bad. A BLOCK graft is very specific and is difficult to do in the lower front single tooth site due to space restrictions between roots. Removing adjacent teeth just to be able to do the graft is a bit odd, UNLESS those teeth need to go too. Then it is a good idea.

      You should have a really experienced implant dentist who does both surgery and makes the tooth look at you. Front teeth are super complex and the stakes are high.

      I hope this helps.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry.

  42. Kate says:

    I had an apic done about 2 weeks ago. Today was the first day I actually got a peak at the area. Back upper left. The gum area above the tooth is white. It doesn’t appear swollen, just whit in color instead of pink. Is this normal? I am not currently having any pain or discomfort.

    • Ramsey Amin DDS says:

      Hi Kate,

      A white surface is normal healing in the mouth if it is an “open” wound allowed to fill in. White pus is not normal.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  43. Michelle says:

    Dr. Amin,

    I had tooth 14 root canaled back in 2000. It did not work the first time and within weeks, it became infected and my dentist at the time retreated it. One day, this past Novemeber, I woke up with the gum above that tooth a little swollen and painful to even touch or brush my tooth brush over it. There wasn’t a pimple or pus, just swollen and the tooth was throbbing me all day. I went to my dentist and he recommened I see an oral surgeon to possibly get it extracted. He felt that if I tried to retreat it, that there isn’t the best possibility that all the infection will ever really be gone.

    Well, I made the appt. with the oral surgeon, but chickened out and canceled. Shortly thereafter, everytime I ate anything sweet, that tooth would throb all day. It was even making all my other teeth hurt. So, I decided to see that oral surgeon afterall. My appt was March 4, 2013. I was starting to get nervous about the extraction and decided to just talk about my options. He told me it was a bad tooth that had an abcess and apicoectomy doesn’t always work. I reluctently had it pulled that day and I now think he just didn’t want to bother with anything else, other than me getting that implant we discussed earlier(more $ for him)

    I am now in so much pain after a month and am seriously regretting my decision. I don’t even want to get the implant by him, so saw another implant specialist who says I now need a bone graft and I should get the implant soon. Do you think this was a good choice and I’ll feel beter after the implant? tmj, pain, gum problems have started since this tooth was pulled :(

    Sorry for this long comment. I hope to hear from you.

    • Ramsey Amin DDS says:

      Hi Michelle,

      Sorry to hear about your dental woes. Unfortunately many root canal teeth end up getting extracted. I have even had to do this on family members :(

      The dental implant is likely to be a predictable, long-term replacement. Please discuss pain management before the procedure. Most of my patients have a 0-2 out of 10 on a pain scale after dental implants and extractions with me.

      Here is a link from a few years ago that might help you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      • Michelle says:

        Dr. Amin,

        Thank you so much for your response. I really appreciate the time you took to do so. The link you recommened for me to take a look at did not show up on your reply. Would you kindly be able to post it for me? Thanks again.

        Michelle

  44. Sonu says:

    Hi doctor(respect)
    one of my front main incisors have been root canaled which lasted for 7-8 years then infection recame last year
    then apicoectomy done infection again recame
    iam with the infection for one year
    what can I do for it a very foul smell comes from my mouth
    I just hate it
    can you give some temporary suggestion for removing for this bad smell

    • Ramsey Amin DDS says:

      Hi Sonu,

      It sounds like the teeth need to be extracted. Despite the root canals and apicoectomies, if the teeth remain infected they have little hope. I would explore removing and replacing them with dental implants.

      Expect to have missing bone in the area from the apicoectomy.

      Good luck,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  45. Armen H. says:

    Hello Doctor

    im 32 years old and about 7 to 8 years ago i had a apicoectomy done on my front top right tooth (second from the middle). this past week i started to feel swelling from the back (inside of my mouth) and a feeling of throbbing, and when pressed i can feel the flesh moving back and forth at the area where the cut was made for the surgery. there is no pain, it just feels numb and a little bit of swelling. i was researching and came to your site. could you please advise me what to do and what might be the problem i have, because i getting the feeling it has formed a new cyst and a new apicoectomy will be needed to save my tooth. please get back to me ASAP i dont want my problem to get worse.. thank you very much and have a great day.

    • Ramsey Amin DDS says:

      Hi Armen,

      Sorry to hear about your tooth. You need to be examined by a dentist to really know what is going on. X-rays are needed.

      You might have a failing apicoectomy and re-infection of the area. You may or may not be able to retreat the area.

      Good luck to you.

      Dr. Amin

  46. Kate Groundwater says:

    Hello Dr. Amin,

    I had a root canal in November 2012 on my second upper molar from the back. It was complicated, requiring an endodontist, who said I had an extra canal and that all the canals were curved. I believe he also said that I had a minor fracture. I have had some minor sensation in the tooth ever since, and recently it began to hurt while chewing hard foods and also with hot foods. I am concerned about this for two reasons. One, I;m not sure what all of my options are (try another root canal, or do an apicoectomy). Two, I don’t want to pay for another root canal, since the last one wasn’t even a year ago and it completely cleaned me out (financially speaking). If I go to the same endodontist, is it accepted professional practice that they redo the root canal free of charge?

    Thanks,

    Kate

    • Ramsey Amin DDS says:

      Hi Kate,

      If the tooth has an internal fracture it has a poor prognosis. I work with many excellent endodontists who excel at what they do.

      Unfortunately if a fracture is present, even the best dentist can’t save it. You should ask the endodontist if it is worth going back inside or do they think you should extract it and have a dental implant.

      Good luck,

      Dr. Amin.

  47. Brenda says:

    Dr. Amin, first thank you for your posts. I can see how you help so many people. I had an apico 7/12/13 – it is now 8/22/13 and i have pain on the tooth (sort of like a bruised tooth). The scar tissue on my gums is such that it hurts to smile and laugh. Now, i have numbness sensation on my upper lip and nose. I feel pressure from my nose to the tooth (#8) My surgeon says it could be the ligament holding the tooth that is inflammed and to give it another week. I’ve been on antibiotics around the clock since 7/5/13. My concern is, if i have the tooth removed and start the implant procedure, what i can i do or ask for in order to make sure the implant is done correctly? There is a hole on my jaw above #8 from the apico – is that filled with cadaver bone or is bone from my jaw/chin best? Again, thank you for your interest in helping us.

    • Ramsey Amin DDS says:

      Hi Brenda,

      Wow, it sounds like you have had quite the ordeal with this bad tooth. :(

      Your questions are really difficult to answer but….you asked about how do you make sure the implant is done correctly.

      My best advice is to see a very skilled implant dentist that is has the training, experience and judgment to handle a case as complex as yours. They will help you make decisions on what type of bone to use, etc. Ideally the same person should do your bone grafting and make the final tooth. Do your due diligence…you are replacing a body part.

      Front teeth are far more difficult than back teeth.

      I hope you get well and get off antibiotics!!!

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  48. Tara says:

    thank you for clarifying my question. I have decided to come see you. I talked to Angie and I have an appointment in about 3 weeks.
    I look forward to meeting you!
    Tara

  49. Jill says:

    Dr. Amin,
    I am trying to find a dentist and medical doctor who can help me determine the best course of action to eliminate systemic infection, namely small intestine bacterial overgrowth (SIBO), caused by toxic infection of root canals in 14 teeth. The root canals were performed 1986-1989 and have unknowingly created a myriad of health issues in the decades since. After years of seeking help from cardiologists, rheumatologists, chiropractors, gastroenterologists, dieticians, etc., I realize the source of the bacteria causing so many varied symptoms is coming from my mouth. My teeth and gums are literally buzzing (tinnitus symptom) with what feels like radioactivity. The sides of my tongue feel it too since it rests beside so much crown metal exposed from receding gums.

    My dentist will not even conduct a routine cleaning without my taking an antibiotic prior to the office visit. Infection at the roots of 14 teeth is apparent on x-rays. When I approached her on the subject of the SIBO and failed root canal connection, she sent me to receive ozone autohemotherapy, with the advice that the teeth be saved at any cost.

    You may guess the autohemotherapy did not work, as it is a blood transfusion, for which the blood cannot reach the dead area of the teeth. If we were to re-clean the roots of all these teeth, could the bacteria possibly all be eradicated within the miles of dentin tubules? Is there any possibility of overcoming the monstrous beast this bacteria has become within my body without removing the teeth?

    I feel I am down to two unsavory choices. Live with the toxic pathogens and the disease they wreak on my body or extract so many teeth that will certainly alter the quality of my life. At least the latter would BE a life; presently I am sliding down a slippery slope of losing hope for a disease-free one. Keeping the teeth “at any cost” is seemingly the cost of my life.

    What to do when so many teeth are involved?

    Thank you for any insight you may offer.
    Jill

    • Ramsey Amin DDS says:

      Hi Jill,

      Wow, what a situation you have. I would suggest seeing and infectious disease specialist in a hospital that has an associated dental school on campus. Having multiple specialists of all types working together should help you get healthy again.

      Keep me posted!

      Respectfully,

      Dr. Amin

  50. Kelly says:

    I really wish I saw that 40% failure rate before I did mine! Mine, didn’t even last 6 month!!! Implant, here I come sadly :( Another few $$ grand.. why not!

  51. JC says:

    Dr. Amin,
    I broke both front teeth in an accident 50 years ago, root canals in both and crowned in the 60’s.

    They became loose and had significant bone loss, so based on my two Drs recommendations, #8 & #9 were extracted, and had socket bone grafts four months ago. The bone grafts healed nicely with no complications.

    About 10 days ago I had implants placed at #8 & #9. Tooth #7 is sensitive. I called my Dr at the 7 day mark about it and he asked me to call him in another week if the tooth was still sensitive. The implant was placed a little close to the tooth according to him. My primary question is: if the tooth needs endo treatment, will it compromise the implant? The tooth has no decay and is not crowned. Or should the implant be removed?

    Your insight would be very helpful in determining what avenues to pursue, thank you!

    • Ramsey Amin DDS says:

      Hi JC,

      Give it time. Only a 3D x-ray will help determine root proximities. Regular x-rays aren’t good enough. How is it now?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  52. Dario says:

    Hi Dr. Ramsey,
    I would like to ask you a question and your opinion. I’ve had a second front tooth, on the right upper part of my jaw done a root canal about 4 years ago, after a while a cyst appeared in the top of the root of this tooth, over the gum. The infection is still there ,so now, I’m debating to have the tooth extracted and the infection removed and be treated with boned graft, in order to be prepared for an implant or have an apicoectomy procedure be done,after hearing all the cons and future complications and not good results of it. What would you suggest for me to do ? I would appreciate your response briefly. Thank you.

    • Ramsey Amin DDS says:

      Hi Dario,

      The question to save or to extract is unique to your situation. I would have to see you to make this determination.

      Ask your dentist which is more predictable? Which will last longer?

      Consult with both a dental implant and root canal specialist.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      http://www.burbankdentalimplants.com

  53. Chris T. says:

    Hello Dr. Amin,

    I read your article and seem to be experiencing the problems you have written about.

    I broke off a small piece of my #15 molar, which I believe already had a cavity in it and may have already been going bad, around april of 2013. I went it in to see the dentist june 31st of 2013 and had found the tooth was in fact going bad. She thought that if I had came in when I actually fractured the tooth I would’ve only been dealing with a crown. Since it wasn’t too far gone, she believed I would be able to save the tooth. And the fun begins!

    So, I went to have a root canal done Aug 12th. After the RCT, I developed chronic sinusitis and the tooth was, and still is percussion, sensitive, especially in one spot of that tooth. It is the only tooth percussion sensitive. When I went back to the dentist, she said everything looked great and the RCT looked phenomenal, according the X-rays, and that the endo even found the fourth root; but, I still had the sinusitis, according to my primary, and was percussive sensitive. The sinusitis failed 3 rounds of antibiotics, starting from the first round before the RCT. The endodontist redid the RCT on Oct 16 2013. This time he filled the tooth with an antibiotic and said if that doesn’t work then he would do an apicoectomy. It’s been a week since and I still have all the same symptoms, which leads me to believe that I may need an apicoectomy.

    It seems to me that my situation aligns with what your article is written about and that this apicoectomy may not work. My question is, if I go through with an apico and it doesn’t work, what is the time frame for the infection to spread to the bone to the point where an implant will act as you described? I ask this question because I am not sure how long it takes for an infection from tooth to spread to the bone.

    Also, will the hole that the endo puts through the bone to reach the roots be a chronic source of problems in the future?

    Is the failure rate of 40% of apicecomies based on your own data or is that statistic found in some literature I can read up on? I found this but it seemed to be of a small sample: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2502352/

    Hopefully my story can help others make an informed decisions and I will keep this blog updated. And thank you Doctor Amin for writing this article. Wish you were in Tampa, FL incase I need that implant. I definitely like the fact that you have the 3-d scanner, less radiation is always a great thing!

    • Ramsey Amin DDS says:

      Hi Chris,

      Is sounds like your #15 is fractured or has more than 4 main canals. Apicoectomies have a higher success when performed by an expert AND the diagnosis is correct. The reality is that not every apicoectomy is created equal and very few are done in an expert fashion. Your tooth and bone anatomy is a huge factor in the success of the procedure also. There are 100’s of studies to show success rates higher and lower than 40%. You have to be careful what you read and who is writing it.

      Your time frame to go to an implant depends on your unique situation. Bone infections don’t usually happen quickly. Make sure you see your endodontist every year after having the apico. 3D’s work great for apicoectomies too!

      I commend your efforts…you are a smart guy!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  54. Jordan says:

    Hi doctor,
    I had a root canal done when I was seven years old after an injury on my upper front left tooth. In August 2013 it was infected and I had the root canal redone as well as a apicoectomy. Since then I have started Invisalign to get my teeth straight and everything was going fine until I went to get a regular teeth cleaning done and now my mouth feels as though I have the same pain right above my injured tooth that I had before I had the root canal and apicoectomy done. I am worried that this will mess up my Invisalign if I need another apicoectomy and root canal. I have an appointment at my dentist Monday, but I’m really dissapointed that this is happening. What do you recommend i do?
    Thanks

    • Ramsey Amin DDS says:

      Hello Jordan,

      During orthodontics teeth often become loose! Teeth that have had root canals and apicoectomies often become even more loose. The teeth are supposed to come loose so that they move and then should retighten after tooth movement has ended.

      This doesn’t mean you’re going to lose your teeth and have dental implants!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  55. Raju says:

    Hi Doctor,

    Six years back I had root canal treatment on the teeth No 8 . After 5 year I got pain on that teeth. Since I am in a different country , the new doctor does not have the history of my issue. So after the X-ray he decided to redo the root canal. Even after the root canal I had the pain. So he went for the Apicoectomy. There was no pain for an year. Just from last week , I am getting the pain. After the X-Ray ,doctor said there is no crack in the root. He does not know why I am seeing this pain. He suggested me to take the antibiotics for 2 weeks. If this is not working he said we can try redoing the apicoectomy. If again this is not working , then he wanted to go with teeth extraction and impact. Since the issue is on the front teeth , I am very much worried. Are we on the right direction? Can you please help me here?

    Thanks,
    Raju

    • Ramsey Amin DDS says:

      hi Raju,

      Most vertical crack lines in teeth cannot be seen on x-ray. Even under high resolution 3-D cone beam imaging, many tooth cracks cannot be seen. You likely have a fracture which would necessitate tooth extraction.

      Sorry for the bad news!! Don’t shoot the messenger!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  56. Rose says:

    Years ago I had a porcelain pin put into my left front eye tooth. It fell out 2x, so the dentist made sure that it would not come out again and so to say glued it in permanently. I know have an abcess form at the toot of that tooth and the dentist can’t get the pin out. What are my options?

    • Ramsey Amin DDS says:

      Hello Rose,

      It sounds like you have a post cemented inside of a tooth that is preventing the endodontist from doing a re-treat root canal through the crown. This is a difficult situation.

      Sometimes the post can be vibrated out with what is called a piezo. If the post cannot be removed, an apicoectomy may be required or you may possibly lose the tooth.

      Good Luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  57. Candy says:

    Hello Dr. Amin,
    In 2010 I had a fall that resulted in a broken front tooth and several of the upper and lower teeth were loosened. The broken tooth had a root canal, a crown.
    [ Unrelated - In 2011 the other front tooth began to die so it also had a root canal done. This resulted in a discolouration over time despite several attempts to have it whitened. Eventually in 2012 keep them visually aesthetic, the older crown was removed and both front teeth were given matching crowns.]
    This year I developed a pus boil above the original broken tooth, an xray revealed a dark area.
    Antibiotics were prescribed since I had no pain in my teeth / gums – but it didn’t help. The dentist suggested to re-do the root canal but was unable to drill through the crown because the original filling was too hard. Eventually an Apicoectomy was performed. Now a month later the gum has healed but the pus boil has returned. I have no pain in my teeth or gums and the boil is easily drained but keeps returning.
    I went back to the dentist and the new x-ray shows nothing wrong.
    The dentist now wants to do a root canal to the tooth on the other side of the broken one as he suspects that might also be infected.

    I’m just a little fed up and don’t want any more root canals on my front teeth :(
    Is there any hope for me at all! Will this end badly if I just leave the boil there and do nothing.

    • Ramsey Amin DDS says:

      Hi Candy,

      Sorry to hear about your misfortunes. A tragic fall can cause a lifetime of dental problems.

      You must treat the roots with the apicoectomies. Do not leave the alone. The pus is acidic and will destroy your bone. You must get this chronic dental infection under control to avoid losing the teeth and eventual dental implants. It will only get worse.

      I would do what your dentist recommend.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  58. stu miller says:

    My 27 year old daughter just had her #13 tooth extracted. She had pain and her dentist took an xray and suggested she get an apicoectomy. We made an appointment for the same day with a maxil-facial surgeon who upon examining her xray said the prognosis was poor for an apico because the infection was above the root and he said there wasn’t that much tooth left to support the post and that it likely would fail. We then opted to pull the tooth. I asked when she would be able to have an implant done and he said it’s best to wait 4 months before doing the implant because new bone would grow and the implant would be most successful as a result. Do you agree that it would be best to wait or go to someone else? My daughter’s dentist called to see how everything went and sounded surprised that she had the tooth extracted. Now in retrospect we’re thinking maybe we were too hasty in extracting the tooth. Too late now but I want to make sure that we do the right thing as far as implants are concerned. She made an appointment with her dentist for this Thursday so we’ll see what he has to say. Is there anything she should be asking him or/and do you have any suggestions? I’d like to hear what you have to say about all this.. Thank you very much.

    • Ramsey Amin DDS says:

      Hello Stu,

      I’m sure the surgeon had an excellent reason to extract the tooth. The tooth probably had a very poor prognosis to have an apicoectomy.

      Keep in mind that doing apicoectomy requires drilling a hole through the bone to access the root and then cut off the end of the root. This removes away bone that would be used for a dental implant. Some apicoectomy is her far more riskier than others.

      Just because the surgeon did not place a same-day immediate dental implant does not mean that here she did something wrong. It sounds like you saw a prudent individual that very carefully calculated your risk versus benefit ratio of an apicoectomy versus extraction and dental implant.

      Your dentist is probably not well-versed in the exact procedure of an apicoectomy so just because they send to you to somebody to have it done, doesn’t mean that it can be done.

      I say this in all due respect. I hope your daughter has a great experience and having a dental implant to replace her missing tooth. Going slow and steady may be the most predictable route even though it is going to take 8-12 months.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  59. diane says:

    Many years I had root canal in two pre molars. The dentist at that time used titanium rods to fill the canal. It seems that I always felt a little pressure above the roots but mostly just when I touched the area. A few years ago I was told the rods had to be removed and I was sent to a specialist who redid the two root canals. Though I have had no pain with these two teeth something did not feel right. I have had root canal before and know there is no feeling in the tooth. However, when I tap on one of the teeth it felt like I had a piece of concrete in my mouth.

    Then I developed this lump on my gum next to the inside of the cheek.the dentist

  60. diane says:

    Many years I had root canal in two pre molars. The dentist at that time used titanium rods to fill the canal. It seems that I always felt a little pressure above the roots but mostly just when I touched the area. A few years ago I was told the rods had to be removed and I was sent to a specialist who redid the two root canals. Though I have had no pain with these two teeth something did not feel right. I have had root canal before and know there is no feeling in the tooth. However, when I tap on one of the teeth it felt like I had a piece of concrete in my mouth.

    Then I developed this lump on my gum next to the inside of the cheek.the dentistSaid my eye tooth, the tooth directly in front of this tooth, had an abscess and he did root canal. It didn’t and was redone. I had a ct scan done. The lump is hard and my dentist feels the tests show a foreign object in the middle of the lump. I am now scheduled for a apicoectomy with bone graft from a cadaver. I thought he was just going to remove the lump. But doing the procedure on my root, is this necessary. Do you have any idea what the lump is. Will this procedure take care of all problems. It is like I have a tooth ache in between the first two teeth and I feel some pressure. I asked to have the eye tooth pulled but was told it would not fix the lump. I have total confidence in my dentist to do the procedure but would like your thoughts and opinion. Thank you

    • Ramsey Amin DDS says:

      Hello Diane,

      It sounds like the lump you have the some type of pathology that requires a biopsy. Without seeing you or your 3-D scan x-rays, there is no way for me to tell you if you’re doing the right thing or not. It sounds like you or in the care of a very good dentist that you have confidence in. That is really important.

      Root canal teeth that still hurt over time are generally either fractured internally or if there are additional root canal nerve endings that were not filled or could not be reached to be filled.

      Good luck with everything.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  61. Raquel says:

    I recently read the article on a failed apicoectomy. I have had two crown replacements on #3, upper right arch; a total of 3 crowns. An endodontist recently recommended doing an reverse root canal to target the 4th root canal and to then do another apicoectomy. According to your article, there is only a 40% success rate. How would we find out if the tooth is viable after all this time to do the above recommended? I really want to save my tooth!! I’m moving to another state in 2 months and I’m trying to figure out if it’s best to get it done now or just go with an implant where I move to…..

    • Ramsey Amin DDS says:

      Hello Raquel,

      Some apicoectomies can last a long time if the tooth has a good prognosis after the procedure is done. The apicoectomy procedure itself may be successful, but the crown and/or surrounding bone may not be so healthy in a few years canal leading to the loss of a tooth that had an apicoectomy. Dental implant may or may not be the best idea. Sometimes the decision is purely a financial because you can dump lot of money into a tooth that will subsequently be extracted. I extracted 7 root canal teeth just yesterday. Some were because of failed root canals, while some were due to a badly decayed crown on a root canal tooth that had very little structure to be saved.

      Typically this additional fourth canal is called “MB2.” When this canal is not filled, it is best to try to redo the root canal to find this canal that conventional and nonsurgical way. Sometimes patients have posts inside of their teeth and it makes removal of the crown very risky so the only option is apicoectomy. Keep in mind that an apicoectomy in the upper right molar as you described is also going to be near your maxillary sinus.

      A very skilled endodontist will be able to guide you properly. Good luck with the move.

      Respectfully,

      Ramsey Amin DDS

  62. Shelley says:

    I had a rood canal on my front top left tooth over 20 years ago. About 6 months ago I started to develop pain and discomfort in the area, as well as constant headaches. I was referred to an endodontist who redid the root canal and performed an apicoectomy. In the last 2-3 weeks I have started feeling discomfort in the area again as well as headaches. I will be going in next week to see the endodontist, but I am worried about future problems and possible bone loss. How common is it that significant bone loss in that area would complicate treatment, and would repeated root canals and apicoectomies result in more bone loss than simply opting for extraction and implant at this point?

    • Ramsey Amin DDS says:

      Hello Shelley,

      Repeated apicoectomy’s would definitely results and more bone loss. Repeated root canals may or may not result in additional bone loss. There only so many times that you can reenter the same tooth and area before there is still a little tooth structure left that a crown would not end up lasting that long. You need to way the pros and cons with a very skilled and experienced implant dentist and endodontist. Only then after a very detailed examination and possible 3-dimensional scan, can you make a really good determination for the longevity of each option.

      Attached is a link to learn more about 3-dimensional scans

      best of luck to you… Ramsey Amin DDS

  63. Amanda says:

    Dear Dr. Amin,

    I’m desperate for an answer. In April I started experiencing swelling on the roof of my mouth near an upper molar. My DDS diagnosed the swelling as an abscess. I was referred to an endodontist who performed an initial root canal. The abscess never subsided. After a second visit, the endodontist said he made “a few adjustments.” Again the abscess never decreased in size. After a third root canal (and the final treatment), the endodontist assured me the tooth was healed. At the time of treatment the abscess had developed into something that resembled a pimple. He punctured it using a syringe and I was told that it should heal. However, it is now three weeks later and the abscess still persists (in fact, it hasn’t changed much since the initial treatment). Do my symptoms indicate that I still have an infection? I can’t find an answer, and I’m uncertain what to do at this point. I’m totally frustrated.

    Any insight you could provide would be tremendously helpful!

    Thank you in advance!
    Amanda

    • Ramsey Amin DDS says:

      Hi Amanda,
      There is a strong possibility that one of your teeth next to this tooth is also dying or dead. Please have your endodontist test that tooth to see whether it is alive or dead.

      Another common thing that occurs is the root canal tooth fractured vertically. If that is the case the tooth will have to be extracted and subsequently replaced with a dental implant. Lastly, additional nerve canals are sometimes missed in upper molars that can lead to a reinfection and secondary abscess.

      Keep me posted with what happens. I understand your frustration. Hang in there. The human body can sometimes be unpredictable!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  64. Lucy says:

    Dear Dr. Amin,
    I have read all posts here.. really feel sorry for all of these folks, including myself. I have had root canal treatment (4 sessions over a period of 1.5 months) on my lower left molar (second to last) with a total of 3 dentists on the same clinic, and the pain never went away completely. I had a CT scan done yesterday after talking to my dentist on the options.
    My dentists all said I have curved canals and showed me on the x ray they could not reach the tip of the root. Some recommended apicoectomy, however here is my dilemma: if the success rate for apico is not very high and the tooth may end up getting extracted down the road.. is it worth trying this?? Of course this will depend on how close to the nerve it is, root length, etc.. but I read from you that bone is extracted to reach the roots and it seems to be an aggressive intervention, which might cause the implant to cause problems in the future once I have it done? I do not think that an apico might be a good option because (1) it is so invasive requiring bone to be drilled, which may cause issues with implants and (2) there is 60% chance of success.. I will see the results of the CT scan with the dentist tomorrow. If he says conditions are okay for an apico, (a) what would you recommend? I find the idea of drilling through my bone, cutting through my gums and having the tip of my roots extracted for a 60% success rate not that much attractive compared to an implant after all. However (b) how long do implants last for? I am only 27 and would need the implant to last for many many years to come.. Thanks for answering to question (a) and (b)

    • Ramsey Amin DDS says:

      Hello Lucy!

      I would recommend that you be evaluated with the 3-D scan. If the outer wall of bone is of reasonable thickness and the route is accessible, then apicoectomy may give you many years of good service. Some apicoectomies work great!

      If they feel like the prognosis is good, then by all means proceed. It is much replace a molar on the lower left that has had an apicoectomy with a dental implant than an upper front tooth that has had an apicoectomy.

      Dental implants are the closest thing to your natural teeth, and just like us, we don’t live forever either. A dental implant may have a lifespan from 10 to 40 years. It depends on a number of factors in there are a few ways to predict success.

      Good luck with everything… I’m sure it will turn out well! ;)

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  65. Nick says:

    Hey Doc,

    I had an apico on one of my front lower teeth 9 years ago. In all the x-rays I’ve seen since then i’ve always seen a dark area by the tooth but it never seemed to get bigger and my dentist never made it an issue. However, I’ve just relocated and went to a new dentist who had an endodontist check it out who x-rayed it and said I need apico again. I have a few concerns:

    It’s my front bottom tooth which is already small to begin with. Is doing another apico going to make it looser?

    Also, since there is still that dark circle by where they did the apico before, does that mean its re-infected since I thought it was normal after an apico to have a dark shaded area like that.

    Please advise and thank you.

    • Ramsey Amin DDS says:

      Hello Nick,

      There should be no dark spots on the x-ray near the roots. When I do an apicoectomy, I always bone graft the hole in use the patient’s own blood to make the graft successful.

      If the root a short and mobile, it may need to be splinted to the other teeth so that it doesn’t move during bone graft healing. Lower front teeth are very tiny by their nature.

      Good luck, I hope it really works out for your this time!

      Here’s some information about bone grafting that you should know:

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  66. Mel says:

    Dear Dr. Amin, I have an infection in my front top tooth that had two failed root canals and now I am told to have an apico by my endo. My main dentist told me before I can get implants I have to get braces to fix my major malloclucion which most likely is the cause of my horribley painful tmj. My tooth has been infected for over a year now and im growing quite concerened over bone loss which my endo told me I have. Should I wait to get implants for braces? Would MMS help to stop with the infection? Thank you.

    • Ramsey Amin DDS says:

      Hello Mel,

      After 2 failed root canals, an apicoectomy may not have a high success rate in your situation. I in fact do perform apicoectomy is when I know the prognosis will be excellent. These are generally for single rooted front teeth and not for molars.

      MMS is some type of homeotherapy I believe that is not likely to be successful. In order to go through your dental reconstruction, your TMJ problems must be absent in your bite should be comfortable prior to starting any implants or significant restorative dentistry. A decision needs to be made soon whether or not this tooth should come out. Braces need to happen prior to dental implants since dental implants cannot move.

      http://www.burbankdentalimplants.com/full-mouth-restoration/

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  67. carla says:

    hi doctor I just had an apicoectomy don’t about a month ago for the second time. I am suddenly feeling discomfort and swelling. I feel hopeless, I’ve had this done before. But after reading this article having a tooth extracted sounds so painful and I’ve never had a tooth extracted before. I went to see a specialist and he fixed it twice, but it’s only been a month. He never said to come back just to do 2 laser treatments to help heal and to cut stitches. no check up.

    • Ramsey Amin DDS says:

      Hello Carla,

      I would suggest you see your Dr. back for a follow-up visit. In my practice I will see 98% of patients back at a one-week follow-up appointment. At this appointment we can be certain that things are healing properly and that there is no presence of infection. If an infection is present oftentimes a second antibiotic is added or antibiotic therapy is changed altogether with a possible culture and sensitivity to make sure that we are treating with the proper antibiotic.

      I do perform apicoectomies, when I know the prognosis will be excellent. This is always combined with a bone graft, membrane, PRF/PRP and sometimes splinting of teeth.

      Keep us all posted on your situation please.

      Very respectfully,
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  68. Jim Gardner says:

    A very interesting article! I am looking at a two implant supported bridge at the upper front and have a problem tooth nearby that has a poor history of root canal work. My dentist is advising against the implant until the nearby infected root situation is resolved and has advised extraction rather than re-root canal/apicoectomy. I’m pondering this as it would mean three implants instead of two (more work/more cost!). Your article has made me think again! Still not sure on whether to treat the infection through extraction or leave well alone and stick with the two implant bridge. The infection isn’t problematic as I haven’t had an abcess now for 3 years (I was getting them annually!)

    • Ramsey Amin DDS says:

      Hello Jim,
      I absolutely love your question. Most dental infections are chronic in nature and cannot be felt by the patient. They are picked up on routine dental x-ray examination has a black spot at the tip of the root.

      Your dentist is absolutely correct in being extremely hesitant to placing implant next to a tooth that has a long-standing chronic dental infection. Your asking for trouble by doing this. Your asking for your dental implant and/or bone graft to fail because of a type of bacteria that is generally walled off within that abscess/black spot of inflammation on your x-ray. It sounds like your dentist has your best interest in mind.

      The health of your dental implants is largely predicted by the health of the natural teeth right next door.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  69. Justin says:

    Hello Dr.
    When i was 8 years old my right central incisor was knocked right out of my mouth… with a tree (yup you read that right). Not only this but my upper jaw was broken in several places. The dental surgeon cemented the tooth back into place and wired my upper teeth together. After he was sure that the jaw had healed and that the tooth would stay he began a root canal procedure. It was successful and for years I have had this tooth which was properly crowned later on in life in my early 20’s. I am now 27 and it appears that there is some decay and a crack on the tooth above the gumline. I am scheduled to see a surgeon on Sept 2nd but am wondering how long this tooth can last before I have it taken care of. My only concern is for the teeth around this tooth, the last thing I would want to do is jeapordize the surrounding teeth because I was hesitant to get the root canal tooth done sooner than later. There is some pain (which I find surprising since the tooth is dead). Thank you in advance for any advice and assistance you can offer.

    Justin

    • Ramsey Amin DDS says:

      Hi Justin,

      No one knows how long this tooth will last. Given the fact that it had issues such a young age, it is likely that you’re going to lose it. Oftentimes teeth that are traumatized undergo a process called resorption where the tooth literally dissolve away. It can become painful even if the tooth had a root canal.

      Your best case scenario would be to replace this tooth with any immediate dental implant considering it is a central incisor. A bone graft will likely need to be done to fill in the void around the tooth socket and the dental implant if it is safe and predictable to be placed on the same day of extraction.

      I know you don’t want to part with your tooth, but it is likely the best case scenario before one day it breaks off entirely. I saw two of these last week alone. It creates quite a cosmetic emergency when your front tooth breaks off to the gumline.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  70. Patty H. says:

    Hello and thank you for the great information. It is very helpful to read all the experiences.

    I have to decide this in 2 days!
    I have been approved for apicoectomies on 10 and 11. tooth #10 with a root canal is at the end of an 8 tooth bridge with 2 teeth on each side holding it in (a car accident 30+years ago and subsequent teeth losses). #11 is a single RC/crowned tooth.

    1 1/2 years ago I lost my bottom molar on my left side and so chewed more on my right side. All good. Then I lost the last 2 teeth on my right side from a failed RC and fracture under a 3 tooth bridge. The surgeon cut the bridge and left one tooth there. This caused me to start chewing on these 10 and 11 teeth more. They got sore and I went to the dentist and he ground them down a bit and referred me to the oral surgeon. Insurance approved apicoectomies for these 2 teeth. But for the past 4 months I have no pain. It all subsided after I quit biting so hard. Also, there has never been an infection and I have only had pain when I chew a lot on them, like meat or hard veggies. I had some pain in the bridge behind it when I had sinus issues but all of it doesn’t hurt at all now.
    The question is, are these apicoectomies necessary? Or should I leave them alone until I would have an infection or some other issues? They are not preventative I suppose or would they improve the life of the teeth?

    I really need implants on these bottom molars so I can start to chew where I should chew and take pressure off of these more fragile teeth? Perhaps this is a better investment?

    Thank you so much.

    • Ramsey Amin DDS says:

      Hi Patty,

      It is very difficult to tell you whether or not you need these apicoectomies without seeing you and your x-rays. Many dental infections that occur around root canal teeth have no symptoms at all. They will simply show as a black spot at the tip of your root on an x-ray. Most of them are not symptomatic until one day they abscess!!!

      If you do have this black spot at the end of your root, this is bone loss and oftentimes an apicoectomy and/or root canal retreatment is indicated. It sounds like you have extensive dental work. I would go with the recommendation of your dentist. Keep in mind that an apicoectomy shortens your roots and may make your bridge looser.

      I would not wait on doing treatment. On another note, you should have a complete evaluation for the health of all of your teeth and try to prevent is much possible dentistry by long-term maintenance.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  71. Christine says:

    About 2 months ago my front tooth abcessed. That was the most awful pain ever. The tooth had a root canal some 30 years ago and had since been crowned. After the infection, the dentist did an apicoectomy. Today, I feel like there is still some feeling in that tooth, not really deep pain but a slight nerve pain sensation. Can that tooth re-abcess? I’m so afraid of that happening again.

    • Ramsey Amin DDS says:

      Hello Christine,

      Yes the tooth can develop another abscess. If it does, the long-term prognosis for this poor and you may end up with a dental implant. When the same tooth becomes reinfected, its prognosis for another third retreatment is not very good. Sorry for the bad news

      Ramsey Amin DDS

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