do I need an apicocectomy?

[JD]

Please could you give me some advice concerning a recent root canl treatment I had done by my dentist 4 weeks ago on my upper right 2nd molar.

The tooth concerned had been mildly sensitive to biting on and off a few months, I saw my dentist in April who took x rays and it all looked fine.

Unfortunately in July it flared up and was extremely painful and I developed a very sore 'gumboil' high up on the gum. I had antibiotics- which helped and my dentist found pulpitis and performed a root canl treatment over several sessions.

During the cleaning of the canals (he found 3) one of his nickel files broke in a curved canal and was irretrievable, my dentist did say though he had irrigated the area well before this happenned so hopefully all the dead and infected tissue was removed.

I can bite painfree (even on raw carrot) and have no pain but still have a remaining sensitive pimple where the hugely inflamed gumboil was and on tapping the tooth it is mildly sensitive. After lying down at night the tooth is sensitive to moving from side to side which settles after I am up for an hour or so. I require no painkillers.

I saw my dentist for follow up this week who wanted to leave things for a few months to see if things settle before calling it a failed treatment and considering an apicocectomy- he wasn't sure retreatment would help due to the broken file.

Just wondered if you thought this was reasonable or whether with my symptoms I should get on with a re treatment etc

Thank you

[Dr Mohsen J. Esfahani]

Thank you for your post. We will need to assess your tooth clinically to be able to tell you the correct treatment. Generally speaking, if an ongoing gum boil exists on the side of the tooth, its an indication of pus being drained through the gum. Its possible that there is still infection at the end of the root and its draining through the gum boil.

I would recommend that you book to see an endodontist for a root canal assessment. If need be, endodontists can sometimes remove fractured files with re-root canal treatment. Re-root treatment is generally a more successful treatment than apicectomy, so if its possible to do that, I would recommend that over apicectomy.

However some files cant be removed with re-root canal treatment and in those cases apicectomy may be your only alternative to extraction.