Re: Failed Apicoectomy?

"Le Huart" <fritzfield@xxxxxxxxxxx> wrote
An endodontist once told me that the success rate of all
apico Tx was 65%. So a 2nd lower molar is probably less. A
second apico on the same tooth is like 35% successfull. An
implant, however, is between 92 and 98 % successful. So
much so that the implants are replaced free of charge by
most companies if they fail (Straumann and Nobel). We
replace the at no charge too. You won't get your 1K back
for a failed endo. I don't think that endodontists have
gotten into the mindset of implants as an alternative
therapy.

It was closer to 1.5k. At this point I am feeling mighty
mistrustful of the endodontist who did this work. He gave
much more hope that the apicoectomy would work, AFAIC.

I am not going to complain. But I learned about implants for
the first time a few months later from a friend, not from
the endodontist. I do think the endodontist had a
responsibility to present this option. So I currently plan
to dump him.

I scheduled an appointment with the endodontist on Feb. 14,
to try to get a decision from him and see if he has anything
intelligent to say about implants. When he prescribed the
amoxicillin last month, he spoke of how we might prescribe
this periodically to keep the infection 'under control.' Now
I think he may have been sort of trying to put off the
inevitable and keep me happy with the apicoectomy.
Infections don't just go away with penicillin and the like,
right? They have to be cut out, generally speaking, or maybe
opened up and thoroughly irrigated (speaking of flesh
infections), right?

OTOH, he'd be a fool to routinely perform molar
apicoectomies that he thinks are likely to fail. Maybe he's
just clueless and inexperienced about success rates.

I am a little concerned that my dentist is hesitant to
criticize the endodontist's work, due to their being members
of the great fraternity. But darn it, I have a new lease on
life due to other things going on here, and I sure as heck
hate postponing the inevitable and wasting all this time
with the apicoectomy. My mouth is a bit foul (bad sign, I
know), too, and dammit, I need good breath(!) for my love
life. I am thinking I want this darn tooth out. I want to
say goodbye to one of the last remnants of my teeth grinding
days (long hours at work, which led to an early retirement,
for good or bad), and let the several month implant process
commence.

The tooth is probably cracked and hopeless. I'd have it
out (could be difficult due to endo brittleness) and place
a socket preservation graft for an implant in 4 months. Of
course, this all begs the question, does one need to
replace a 2nd molar? In the cash register free US Army we
usually triaged 2nd molars for extraction unless it was
the only molar the patient had.

Isn't the point of a bridge or implant to keep the
surrounding teeth from caving into the empty socket? So no,
I am not understanding your last two statements above.

This should confuse you but also help you ask more
questions and seek answers from other clinicians and the
internet.

Right. Thank you.


.

Relevant Pages

  • Re: Failed Apicoectomy?
    ... If no change or if pain begins, see the endodontist, he said, and keep his office posted as well. ... Is the jury truly still out on whether an apicoectomy should be pitted against an implant as far as options when a root canal fails? ... P.S. Endodontists generally are NOT trained in endosseous implants. ...
    (sci.med.dentistry)
  • Re: Failed Apicoectomy?
    ... predictability of implants in the lower 2nd molar region ... implants placed over time in the same individual. ... home is that osseointegration is a progressive phenomenon ... enough evidence that some are doing just that. ...
    (sci.med.dentistry)
  • Re: havent seen dentist in 7 years
    ... >>>the tooth and root was legitimately decayed beyond repair. ... Many decisions to get implants are based upon oogling ... >>>without a molar for the next 4 months and, ... > get an implant earlier and a crown in 4 months. ...
    (sci.med.dentistry)
  • Re: havent seen dentist in 7 years
    ... >>the tooth and root was legitimately decayed beyond repair. ... Many decisions to get implants are based upon oogling ... >> I'm not sure a vanity tooth would work for a molar though since ... get an implant earlier and a crown in 4 months. ...
    (sci.med.dentistry)
  • Re: Failed Apicoectomy?
    ... An apico on a lower 2nd molar is very difficult and guarded as to success at best.b We are into the age of evidenced based medicine. ... Autopsy studies from ITI have shown a greater degree of osseointegration in older similar implants placed over time in the same individual. ... While it is illegal and unethical to guarantee a medical/dental outcome, the manufacturers of implants have enough evidence that some are doing just that. ...
    (sci.med.dentistry)