Hi sbbi,

For everyone reading this and any of my previous posts...just so I am being clear about my writings with regard to root canal treatment.... they are not what the typical dentist will inform you about UNLESS you know the right questions to ask him. No dentist in good conscience can honestly say that root canaled teeth are free of infection because they know the anatomy of the tooth and know the microscopic canals cannot be debrided. They also know that the medicaments used to irrigate the large canals cannot be "rinsed" away and the gutta percha material used to "fill" the canals are both highly toxic. These stay present in the tooth for the life of the tooth. It wasn't long ago that "formaldehyde" was the irrigating solution.... some still use it today in spite of the warnings not to use it.

Endodontics is a treatment option that should be presented to a patient simply because it is in the category of treatment options. But with all treatment options, enough information should be disclosed to the patient so he/she can make an informed decision.

With regard to the infection at the apex of tooth #3... it is blatant on the xrays and you should have been told. However, in defense of the dental profession (and I mean that sarcastically), it is also COMMON to see these pathological areas at the apex of root canaled teeth because it is the bacteria proliferating out of the apex into the jawbone. Dentists are not physicians, many of them believe that the teeth are a separate entity from the rest of the body. They consider these "areas" to be a "typical" reaction to root canal therapy. It is often not considered an abnormality until the areas grow very large and/or swelling occurs and/or the patient chronically complains about the tooth.

An apicoectomy is a treatment option and here are the details of the surgery....an incision is made in the gum above the roots of the tooth, the tissue is flapped back and a drill is used to make a large "window" opening into the jawbone to gain access to the roots of the tooth. Once in there, the tips of the roots are cut off, the gutta percha is scraped out of the large canals, small files are used to scrape away debris stuck to the walls of the large canals, irrigation is used, new gutta percha is then melted into these canals, mercury filling material is used to close off the open ends of the root tips in the jawbone, and the flap is sutured closed. In a sense, it is a root canal from the end of the root down to the biting surface, instead of from the biting surface up to the root.

As you can see from my description, apicoectomies basically serve the same purpose as the root canal. The reason they are done is because the tooth is in a fragile state and to perform a "conventional" root canal on it again, could mean perforating the side walls of the tooth. There is still no access to the microscopic canals, so the tooth remains infected.

In a little while I am going to post another reply to answer your question about socket preservation.

Bryanna