Dental Cysts: Micro-Apex Surgery vs. Root Canal Re-treatment

A dental abscess at the gum line of the front tooth?

A dental abscess has developed on my front tooth.
Four years ago, this tooth underwent root canal treatment, and a dental post was placed along with a 3D dental crown.

Q1: Over these four years, I still feel a slight sensation when lightly pressing on the affected tooth (shouldn't there be no sensation after a root canal?).
Does this indicate that the root canal was not thoroughly cleaned? The clinic drilled a hole in the crown to attempt a retreatment but discovered a dental post inside.
They lacked the expertise to remove the post, so they filled it back in and advised me to go to a major hospital to have the post removed before returning to the clinic for retreatment.
The major hospital suggested performing an apicoectomy to preserve the crown and save the hassle of follow-up visits after retreatment.

Q2: If there is an infection in the root canal, will choosing the apicoectomy truly eliminate the dental abscess? And if I opt for retreatment, which only cleans the root canal, will it effectively resolve the apical inflammation? I've been hesitating for days about whether to proceed with the apicoectomy or retreat the root canal.
I would greatly appreciate the guidance of a skilled dentist.

Xiao Mei, 20~29 year old female. Ask Date: 2016/01/25

Dr. Zeng Guanghui reply Dentistry

1.
In the aforementioned situation, there may still be an infection in the root canal after root canal treatment, or there may be a crack in the tooth.
If retreatment is necessary and the post is difficult to remove, an apicoectomy can be performed to preserve the post and crown while thoroughly cleaning the root canal.
2.
If the root canal is cleaned properly, the periapical lesion will naturally resolve.
However, if there is a crack in the tooth itself, the prognosis is poor, and extraction of the tooth may be the only option.

Reply Date: 2016/01/25

More Info

When dealing with dental issues such as cysts or persistent pain after root canal treatment, it is essential to understand the underlying causes and the available treatment options. In your case, you have a dental cyst on a tooth that has previously undergone root canal treatment and has a post (牙釘) placed in it. The presence of discomfort when pressure is applied to the tooth suggests that there may still be some infection or inflammation present, which could indicate that the root canal treatment was not entirely successful.

Understanding the Situation
1. Root Canal Treatment and Its Limitations: Root canal treatment aims to remove infected or damaged pulp tissue from the tooth and seal the canal to prevent future infections. However, if the cleaning and sealing are not thorough, bacteria can remain, leading to persistent pain or the formation of a dental cyst. The fact that you still feel some sensation in the tooth after the treatment could suggest that the root canal was not completely effective, or there may be other issues such as a crack in the tooth or an infection in the surrounding tissues.

2. Dental Cysts: A dental cyst is a sac filled with fluid that can form in the jawbone or around the roots of teeth. They often arise due to chronic inflammation or infection and can cause pain, swelling, or discomfort. If left untreated, they can lead to more significant issues, including bone loss.

Treatment Options
1. Micro-Apex Surgery (Apicoectomy): This surgical procedure involves removing the tip of the tooth root along with any infected tissue. It is often recommended when a root canal treatment has failed, and there is a persistent infection or cyst. The advantage of this procedure is that it can preserve the tooth and any existing restorations (like your crown), potentially saving you from more invasive treatments like extraction. Success rates for apicoectomy are generally good, especially when performed by an experienced endodontist.

2. Root Canal Re-treatment: This option involves reopening the tooth, removing the previous filling material, and thoroughly cleaning and disinfecting the root canals before resealing them. This can be effective if the original treatment was inadequate. However, if there is a post in place, it may complicate the process, as removing the post can be challenging and may require specialized techniques.

Decision-Making
When deciding between micro-apex surgery and root canal re-treatment, consider the following:
- Condition of the Tooth: If the tooth is structurally sound and there are no cracks, micro-apex surgery may be a viable option. However, if there are concerns about the integrity of the tooth, re-treatment might be necessary.

- Presence of the Post: If the post complicates re-treatment, micro-apex surgery may be preferable as it allows for the removal of the infected tissue without the need to deal with the post.

- Consultation with Specialists: Since you have already been referred to a hospital for further evaluation, it would be beneficial to consult with an endodontist who specializes in these types of procedures. They can provide a detailed assessment and help you weigh the pros and cons of each option based on your specific situation.

Conclusion
In summary, both micro-apex surgery and root canal re-treatment are valid options for addressing your dental cyst and persistent pain. The choice between the two should be based on the condition of your tooth, the presence of the post, and the recommendations of your dental care team. It is crucial to address these issues promptly to prevent further complications and ensure the long-term health of your dental structures. Always communicate openly with your dentist about your concerns and preferences to arrive at the best treatment plan for your needs.

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