Persistent Abscess After Microscopic Root Canal Treatment: Is Surgery Necessary?

The abscess is still present after microscopic root canal treatment?

I have had a dental abscess on my lower molar for almost six months now.
Three months ago, I was referred to an endodontist.
Initially, the doctor said that there was a cavity in the tooth, allowing bacteria to invade, and that the nerve had already died.
He insisted that I needed a microscopic root canal to eliminate the bacteria; otherwise, it wouldn't heal.
After undergoing three sessions of microscopic root canal treatment, the abscess did not resolve.
The doctor then stated that surgery would be necessary to cut open the gum and scrape away the bacteria for proper healing, and that there would be additional charges for the surgery.
This makes me feel like the previous microscopic root canal treatments were a waste of time and money.
Today, I agreed to spend money because I trusted the doctor, but in the end, not only has the treatment not worked, but I also have to pay extra for surgery.
If the surgery doesn't work either, will I be told that this tooth must be extracted and replaced with a prosthetic? It feels like an endless cycle.
Initially, it was agreed that the microscopic root canal would resolve the issue, but now there are additional surgery fees.
Is this reasonable, doctor?

w, 30~39 year old female. Ask Date: 2017/01/18

Dr. Huang Tingfang reply Dentistry

Dear Ms.
W,
Hello! Based on what you described, your dental condition is indeed quite serious.
The dentist will perform a microscopic root canal treatment to thoroughly clean the root canal.
If there is a significant lesion at the apex of the tooth root, surgery may be required, which will be out-of-pocket expenses.
You may need to consider the addition of bone graft material and a regenerative membrane.
Please communicate further with your dentist.
Thank you! Wishing you safety and health!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2017/01/18

More Info

When dealing with a persistent abscess after microscopic root canal treatment, it can be frustrating and concerning, especially when the initial treatment does not yield the expected results. Your situation, where a small molar has developed an abscess for nearly six months despite undergoing three sessions of microscopic root canal therapy, raises several important considerations regarding the necessity of further surgical intervention.

Firstly, it is essential to understand that the primary goal of root canal treatment is to remove infected tissue and bacteria from the root canal system, thereby alleviating pain and preventing further infection. However, in some cases, the infection may persist due to various reasons, including complex root canal anatomy, the presence of additional canals that were not adequately treated, or the formation of a persistent abscess that may require surgical intervention.

The recommendation for surgery, such as an apicoectomy, which involves removing the tip of the tooth root and any surrounding infected tissue, is often considered when conventional root canal treatment fails to resolve the infection. This procedure aims to eliminate the source of the infection and can be a necessary step in preserving the tooth. However, it is understandable to feel apprehensive about the prospect of additional costs and the possibility that the surgery may not resolve the issue.

Regarding your concerns about the costs associated with the surgery, it is important to have a clear discussion with your dentist or endodontist about the treatment plan, including the rationale for the surgery and the expected outcomes. It is also reasonable to inquire about the potential for further complications, such as the need for tooth extraction if the surgery does not succeed. A good practitioner should be transparent about the risks and benefits of each treatment option and provide you with a comprehensive understanding of your situation.

In terms of whether the previous microscopic root canal treatments were in vain, it is crucial to recognize that dental treatments can sometimes be unpredictable. Factors such as the complexity of the tooth's anatomy, the extent of the infection, and the body's response to treatment can all influence the outcome. While it may feel like a cycle of endless treatments, each step taken is aimed at addressing the underlying issue, and sometimes additional interventions are necessary.

If you are feeling uncertain about the proposed surgical intervention, seeking a second opinion from another dental professional can provide you with additional insights and help you make an informed decision. It is essential to feel confident in your treatment plan and to understand all available options, including the possibility of extraction if the tooth cannot be saved.

In summary, while surgery may be necessary in your case to address the persistent abscess, it is vital to have open communication with your dental provider regarding the reasons for this recommendation, the associated costs, and the potential outcomes. If you feel uncomfortable with the proposed plan, do not hesitate to seek a second opinion to explore all possible avenues for treatment. Your oral health is paramount, and you deserve a treatment approach that aligns with your needs and expectations.

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