Post-Endodontic Surgery Complications: Your Options

Post-operative complications of apicoectomy?

Hello Doctor: I had a root canal treatment on my front tooth 10 years ago and replaced the crown with two separate all-ceramic crowns three years ago.
At that time, an X-ray showed a shadow on tooth 12.
The doctor said to monitor it and consider surgery if it increased in size.
For many years, there were no visible changes or discomfort.
However, this year, a different dentist reviewed the X-ray and noted that the shadow had grown to 1 cm, located between teeth 11 and 12, closer to 12.
They recommended immediate surgery.
On January 5, during surgery at Linkou Chang Gung Memorial Hospital, the doctor removed the root of tooth 11 and said they would preserve the vitality of tooth 12.
A month later, a red spot appeared on the gum near my nose.
Chang Gung diagnosed it as an infection, leading to a debridement surgery on March 30.
Later, the clinic found that tooth 12 had lost its vitality.
Since the surgery a month ago, I have experienced tenderness below my right nostril, and the red spot on the gum has not disappeared or changed.
Before the surgery, Chang Gung did not inform me about better out-of-pocket materials or the option for microscopic surgery, nor did they mention that the interproximal gums would recede post-surgery.
The gums in the surgical area still feel numb.
There was also no explanation provided for the biopsy results.
It wasn't until I researched online that I discovered so much information that had not been disclosed.
The follow-up X-ray showed that the shadow had decreased and concentrated on tooth 12, but Chang Gung stated that their endodontics department would need to wait six months and recommended that I seek root canal treatment for tooth 12 at an outside clinic.
I have already undergone five sessions of root canal treatment and medication changes, but there has been no improvement.
Could you please provide me with some treatment suggestions? Thank you.
P.S.
I had no discomfort before the surgery, so I don't understand why my condition has worsened afterward.
I originally planned to conceive and have a child after the surgery, but now I feel very helpless and sad.

Xuan Er, 30~39 year old female. Ask Date: 2015/10/28

Dr. Zeng Guanghui reply Dentistry

In the above situation, it is recommended to consult an endodontist to evaluate whether a root-end surgery on tooth #12 is necessary to completely eliminate the infection in the interradicular area.

Reply Date: 2015/10/28

More Info

Post-endodontic surgery complications can be quite distressing, especially when they lead to unexpected outcomes and prolonged discomfort. Based on your detailed account, it seems you have been through a challenging journey with your dental health, particularly concerning your teeth 11 and 12. Let’s break down your situation and explore potential options moving forward.

Firstly, it’s important to understand that complications following endodontic surgery can arise for various reasons. In your case, the initial root canal treatment and subsequent surgeries were intended to address the infection and preserve the vitality of tooth 12. However, the emergence of a red spot on the gums and persistent pain in the area near your nose suggests that there may still be an underlying infection or inflammation that needs to be addressed.

1. Understanding the Complications: The red spot you mentioned could be a sign of a localized infection or a residual abscess. This can occur if bacteria remain in the area after surgery or if there is a failure to completely remove the infected tissue. The fact that tooth 12 has lost vitality indicates that the infection may have compromised its health, leading to necrosis of the pulp.

2. Treatment Options: Given that you have already undergone multiple treatments, including root canal therapy for tooth 12, it may be beneficial to consider the following options:
- Retreatment of Tooth 12: If the root canal treatment has not resolved the issue, a retreatment may be necessary. This involves removing the existing filling material, cleaning the canals again, and sealing them properly.

- Apicoectomy: If the infection persists despite retreatment, an apicoectomy (surgical removal of the tip of the root) may be indicated. This procedure can help eliminate any remaining infection and preserve the tooth.

- Consultation with a Specialist: Given the complexity of your case, seeking a consultation with an endodontic specialist or a periodontist may provide additional insights. They can assess the situation more thoroughly and suggest advanced treatment options, such as the use of a microscope for better visualization during procedures.

3. Addressing Post-Surgical Symptoms: The numbness and discomfort you are experiencing in the surgical area could be due to nerve irritation or damage during the procedure. It’s crucial to communicate these symptoms to your dentist or oral surgeon, as they may need to evaluate the area for any potential nerve involvement or other complications.

4. Managing Expectations: It’s understandable to feel anxious about your dental health, especially with plans for pregnancy in the future. It’s essential to prioritize your oral health before proceeding with such significant life changes. Discuss your concerns with your healthcare provider, who can help you navigate your treatment options while considering your overall health and future plans.

5. Follow-Up Care: Regular follow-up appointments are crucial to monitor the healing process and ensure that any complications are addressed promptly. If you notice any changes in symptoms or new concerns arise, don’t hesitate to reach out to your dental care provider.

In summary, while your situation is understandably distressing, there are several avenues to explore for treatment and management of your symptoms. It’s vital to maintain open communication with your dental care team and advocate for your health. Seeking a second opinion or consulting with specialists may provide you with the reassurance and clarity you need to move forward. Remember, your oral health is an integral part of your overall well-being, and addressing these issues now will help pave the way for a healthier future.

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