Persistent Gum Swelling After Microscopic Root Canal Treatment: What to Do?

Q: Persistent Gum Swelling After Microscopic Root Canal Treatment: What to Do?

Hello： It is recommended to observe first. <br>After a simple microsurgery, the body also needs time to recover. <br>If there is still gum swelling and pain after six months, then consider whether other procedures "for the purpose of placing dentures" are necessary. <br>Apex root

Swelling of the gums persists after microscopic root canal treatment?

Hello, I would like to ask for your advice.
After undergoing root canal treatment at a clinic, my gums continued to swell, so I went to a hospital for microscopic root canal treatment.
After that, a CT scan showed no significant issues or cracks, but my gums still swell.
The hospital physician assessed that an apicoectomy could be performed and advised me to go back to the original clinic for crown lengthening, placing a post, and a temporary crown.
This would be better for the surgery.
However, the clinic's dentist mentioned that performing crown lengthening first would involve removing some bone, and if the apicoectomy fails or if cracks are discovered later, it would be unnecessary bone removal, which could negatively impact future implants.
They suggested performing the apicoectomy first, followed by placing the post and crown.
Both sides seem to have valid points.
I would like to know what would be the best course of action.

Vexy, 40~49 year old female. Ask Date: 2023/11/24

Dr. Lin Jiayong reply Dentistry

Hello: It is recommended to observe first.
After a simple microsurgery, the body also needs time to recover.
If there is still gum swelling and pain after six months, then consider whether other procedures "for the purpose of placing dentures" are necessary.
Apex root surgery is performed to remove an unknown source of infection.
If the CT scan shows no significant issues, it is advisable to continue observation and follow up at the original hospital.

Reply Date: 2023/11/24

More Info

Persistent gum swelling after microscopic root canal treatment can be a frustrating and concerning issue. It is essential to understand the underlying reasons for this swelling and the appropriate steps to take in addressing it.
After a root canal treatment, it is not uncommon for patients to experience some degree of swelling or discomfort. This can be due to inflammation in the surrounding tissues as the body responds to the treatment. However, persistent swelling, especially if it continues for an extended period, may indicate that there are unresolved issues that need to be addressed.

In your case, it seems that you have undergone both conventional root canal treatment and microscopic root canal treatment, followed by a CT scan that did not reveal any fractures or significant issues. Despite this, the persistent gum swelling suggests that there may still be an underlying problem, such as residual infection, inflammation, or even a reaction to the materials used during the treatment.

The recommendation from the hospital to consider an apicoectomy (root-end surgery) is a common approach when conventional treatments do not yield satisfactory results. This procedure involves removing the tip of the tooth root along with any infected tissue, which can help alleviate symptoms and promote healing. However, it is crucial to weigh the potential risks and benefits of this procedure, especially considering your concerns about bone removal and the implications for future dental work, such as implants.

The advice from your original dental clinic regarding the order of procedures—performing crown lengthening before the apicoectomy—also has merit. Crown lengthening can help expose more of the tooth structure, making it easier to place a crown afterward. However, as you mentioned, this procedure can involve removing some bone, which may complicate future treatments if the apicoectomy does not succeed or if there are hidden fractures.

In deciding the best course of action, consider the following:
1. Consultation with Specialists: It may be beneficial to seek a second opinion from an endodontist (a specialist in root canal treatments) or an oral surgeon. They can provide insights based on their expertise and experience with similar cases.

2. Understanding Risks and Benefits: Discuss the potential outcomes of both procedures with your dentist. Understanding the likelihood of success, recovery time, and any risks involved will help you make an informed decision.

3. Monitoring Symptoms: If the swelling is accompanied by pain, fever, or other concerning symptoms, it is crucial to address these immediately. Persistent swelling can sometimes indicate an ongoing infection that may require antibiotic treatment or further intervention.

4. Long-term Considerations: Think about your long-term dental health. If you are considering implants in the future, it is essential to ensure that any current issues are resolved to avoid complications later.

In conclusion, while both treatment paths have their advantages, the decision should be based on a thorough evaluation of your specific situation, the potential for successful outcomes, and your overall dental health goals. Open communication with your dental care providers will be key in navigating this process and ensuring that you receive the best possible care.

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