Should You Extract a Tooth with a Root Abscess After Root Canal Treatment?

Q: Should You Extract a Tooth with a Root Abscess After Root Canal Treatment?

Dear Ms. <br>Mimi： If the fifth tooth has micro-cracks, the prognosis will still be poor even with re-root canal treatment in the future, so extraction is recommended. <br>As for the fourth tooth, if the apical lesion is small, re-root canal treatment can be considered; however,

Does a tooth that has undergone root canal treatment and developed an apical abscess need to be extracted? Is a second root canal necessary for an apical radiolucency?

In mid-September, I accidentally bit down on a chopstick with my upper left teeth, around the third, fourth, or fifth tooth.
A week later, I visited a doctor and had an X-ray taken.
My family physician said it looked like there was nothing wrong.
At the beginning of October, I noticed a small abscess forming on the inner side of my upper left fifth tooth (No.
25).
Since it wasn't painful, I didn't pay much attention to it until early November when I realized it hadn't gone away and decided to see my family dentist.
The dentist mentioned that abscesses on the inner side of teeth are usually caused by apical periodontitis.
An X-ray of the affected tooth showed no apparent issues, but the X-ray of the adjacent fourth tooth (No.
24) revealed a significant shadow.
At that time, since there were no obvious symptoms, the dentist advised me to monitor the situation.
Both of these teeth had undergone root canal treatment over ten years ago, and both were protected with crowns after the treatment.
Concerned that the apical inflammation might worsen and that I was starting to feel a dull pain in my upper left teeth, I later consulted a specialist in endodontics at a major hospital.
The doctor used a root canal tracing technique to take an X-ray and confirmed that the source of the abscess was indeed the fifth tooth.
The doctor mentioned that during the tracing, the soft tip could not reach the apex of that tooth (it stopped halfway), and considering my previous incident of biting down on a chopstick, there was a suspicion of a possible micro-crack in that tooth.
Although the X-ray did not show any visible cracks, the doctor recommended extraction as a better option, while suggesting that the fourth tooth with the shadow on the apex should undergo retreatment.
Currently, the abscess has been slowly enlarging, and the gums around it have started to become red and swollen.
I am experiencing dull pain and percussion pain in both the fourth and fifth teeth, with the percussion pain and dull ache in the fourth tooth being more pronounced than in the tooth with the abscess.
I am hesitant about whether to extract the fifth tooth directly.
Should the fourth tooth undergo retreatment or an apicoectomy?

mimi, 40~49 year old female. Ask Date: 2023/11/21

Dr. Zeng Guanghui reply Dentistry

Dear Ms.
Mimi: If the fifth tooth has micro-cracks, the prognosis will still be poor even with re-root canal treatment in the future, so extraction is recommended.
As for the fourth tooth, if the apical lesion is small, re-root canal treatment can be considered; however, if the apical lesion is larger, apicoectomy should be considered.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/11/21

More Info

When faced with a root abscess after root canal treatment, the decision to extract the affected tooth can be complex and requires careful consideration of various factors. In your case, it appears that you have a history of root canal treatments on both the fourth and fifth teeth, and now you are experiencing complications, including a persistent abscess and symptoms of discomfort.

Understanding Root Abscesses
A root abscess typically occurs when bacteria infect the pulp of a tooth, leading to inflammation and pus formation. This can happen even after a root canal if the treatment was not entirely successful, if there is a new infection, or if there is a fracture in the tooth that allows bacteria to re-enter. The presence of an abscess indicates that the body is trying to fight off an infection, and if left untreated, it can lead to further complications, including the spread of infection to surrounding tissues.

Treatment Options
1. Extraction of the Affected Tooth: If the fifth tooth (No. 25) is the source of the abscess and the root canal treatment has failed, extraction may be the most straightforward solution. This is especially true if there is evidence of a micro-crack or if the tooth is deemed non-restorable. Extracting the tooth can help eliminate the source of infection and prevent further complications.

2. Retreatment of the Root Canal: For the fourth tooth (No. 24), if there is significant shadowing on the X-ray and symptoms of pain, a retreatment of the root canal may be necessary. This involves reopening the tooth, cleaning out the infected material, and sealing it again. If the retreatment is successful, it can save the tooth and restore its function.

3. Apicoectomy (Root-End Surgery): If retreatment is not feasible or if the infection persists after retreatment, an apicoectomy may be considered. This surgical procedure involves removing the tip of the root and any infected tissue, followed by sealing the root end. This can be a viable option if the tooth is otherwise healthy and has a good prognosis.

Factors to Consider
- Symptoms: The presence of pain, swelling, and the size of the abscess are critical indicators. If the symptoms are worsening, it may suggest that the infection is spreading, which could necessitate more urgent intervention.

- Tooth Structure: The integrity of the tooth is essential. If there is significant structural damage or if the tooth is deemed non-restorable due to cracks or decay, extraction may be the best option.

- Overall Health: Your general health and any underlying conditions can influence treatment decisions. For instance, if you have a compromised immune system, it may be more critical to address the infection promptly.

Recommendations
Given your situation, it is advisable to follow through with the recommendations of your dental specialists. If the fifth tooth is indeed the source of the abscess and is not responding to treatment, extraction may be warranted. For the fourth tooth, if the symptoms persist, a retreatment or apicoectomy should be considered based on the dentist's evaluation.

Follow-Up Care
After any procedure, whether extraction or retreatment, follow-up care is crucial. This includes monitoring for signs of infection, managing pain, and ensuring proper healing. Additionally, discussing options for tooth replacement, such as implants or bridges, should be part of your long-term dental plan.

In conclusion, while the decision to extract a tooth with a root abscess after root canal treatment can be difficult, it is essential to prioritize your health and address the infection effectively. Consulting with your dental specialists and considering their recommendations will help guide you toward the best outcome for your dental health.

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