Dealing with Post-Root Canal Abscess: What Are Your Options? - Dentistry

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Please provide information regarding issues related to abscesses after root canal treatment?


Hello Doctor, my question is that about 8 years ago, I had a root canal treatment on this tooth and had a crown placed.
During this time, there have been occasional flare-ups due to cleaning issues, but this year, after a crown fracture, I had a new crown placed.
Recently, this tooth has started to develop an abscess.
Initially, I returned for a follow-up, and the doctor treated it with medication, but there was no improvement.
On the second visit, the doctor performed a water laser treatment, which was ineffective.
On the third visit, the doctor suggested intensifying the water laser treatment, as the previous cleaning might not have been thorough.
Now I am under observation and asked the doctor what to do if this treatment is also ineffective.
The doctor's response was to perform a gingival incision to address the root, which I believe is an apicoectomy, right? I would like to know if this procedure will resolve the abscess issue for me, or if, as mentioned online, there is about a 50% chance of success, meaning I might need further treatment? Or is there a better approach?

Xiao, 20~29 year old female. Ask Date: 2016/02/25

Dr. Zeng Guanghui reply Dentistry


In the above situation, it is possible that the tooth previously treated with root canal therapy has a periapical bacterial infection.
Consider performing an apical surgery to open the gums, thoroughly clean the infected area at the root tip, and then refill with medication.
It is advisable to consult an endodontic specialist for further evaluation and treatment.

Reply Date: 2016/02/25

More Info


Dealing with a post-root canal abscess can be quite challenging, especially after a long period of time since the initial treatment. It sounds like you've been through a series of treatments, including medication and laser therapy, but the persistent issue of a pus-filled abscess indicates that the underlying problem has not been fully resolved.
When a tooth has undergone root canal therapy, it is meant to remove infected tissue and seal the tooth to prevent further infection. However, sometimes the infection can persist or recur, leading to the formation of an abscess. This can occur for various reasons, including incomplete cleaning of the root canals, new decay, or a fracture in the tooth that allows bacteria to re-enter.

Your dentist's suggestion of performing an apicoectomy (root-end surgery) is a common approach when conservative treatments fail. During this procedure, the dentist or endodontist will make an incision in the gum tissue to access the root tip of the tooth. The infected tissue is removed, and the end of the root is sealed to prevent further infection. This procedure can be quite effective, and many patients experience relief from symptoms and resolution of the abscess afterward.

However, as you mentioned, there is still a chance that the abscess may not resolve completely, and the success rate can vary. Factors influencing the success of an apicoectomy include the complexity of the root canal system, the presence of any additional infections, and the overall health of the tooth. Some studies suggest that the success rate for apicoectomy can range from 60% to 90%, depending on these factors.

If the apicoectomy does not resolve the issue, or if the tooth is deemed non-restorable, extraction may be the next step. While losing a tooth is not ideal, it may be necessary to prevent further complications, such as the spread of infection to surrounding teeth or tissues.

In addition to surgical options, you might also consider consulting with an endodontist, a specialist in root canal treatments, for a second opinion. They may offer additional insights or alternative treatment options that could be beneficial for your situation.

In summary, while an apicoectomy can potentially resolve the issue of a post-root canal abscess, it is not guaranteed. The success of the procedure depends on various factors, and there remains a possibility of needing further treatment, including extraction. It’s essential to have an open discussion with your dentist about your concerns and the best course of action moving forward. Regular follow-ups and good oral hygiene practices will also play a crucial role in maintaining your dental health post-treatment.

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