I just wanted to do an update and get any advice because I am not sure what to do from here. I saw my endodontist today and he did see an infection in the tooth that I had retreated 10 months ago. He recommended doing an apical curretage to clean the infection out OR the tooth will have to be extracted. If the tooth is extracted, I would need an implant.
I am not really sure where to go from here but I know I need to do something so the infection doesn't get worse.
Also, there is a fairly firm large bulge near the root tip between the RTC tooth and the one next to it. Will this disappear after having the surgery or extraction?

Hi lyssa,

The surgery your endodontist talked about is called an apicoectomy. It is a surgical root canal. It serves the same exact purpose as the 2 root canals that you have already had done. Which means it will not solve the infection. The only difference between the apico and the traditional root canal is the way the procedure itself is done, neither treatment has an advantage over the other. The apico procedure is done from the bone level down through the tooth as opposed to doing it from inside the tooth up to the bone.

You are fortunate that this dentist offered you the option of removing this tooth as that indicates that even he knows this tooth is hopeless. The one thing he may have neglected to tell you is that the longer this tooth is present the more aggressive the infection will be and the chances of replacing it with an implant in the future will be compromised at best.

I'm going to give you a visual of the difference between doing the apico and removing the tooth. In your case due to the large infection in the bone, the apicoectomy procedure is done like this...

The dentist makes a deep incision high in your gum above the root of this tooth. He then flaps open a large area of gum tissue and exposes the bone. Then cuts a window into the bone, removes this piece of bone to expose only the area of infection that he can visually see. He uses various drills and other instruments to remove the cyst (this is the large lump you described) and then uses various reamers/ files to remove infected debris from the large canals inside of the tooth from that same location. He then plugs up the large canals with gutta percha material (same as you had during both root canal procedures) and plugs up the hole that he made in the bone with either "mercury" filling material or some other toxic filling. Sutures the incision closed.

Removal of this tooth...
Extracts the tooth and uses instruments to remove the cyst and debride the necrotic bone and tissue until it is visually clean. There may or may not be a sinus communication... if there is, then that would be evaluated at the same time for repair or left to heal on it's own. He may or may not place some bone graft material inside of the surgical socket.... depends on the amount infection found and the degree of bone deterioration from the infection.

The bottom line is this ... keep the tooth, keep the infection and continually deal with the oral and systemic consequences of that. Only to inevitably lose the tooth anyway and reduce your replacement options due to the chronic deterioration of the jaw bone. Or remove the tooth which means to remove the cause of the infection. Depending on the current health of the bone and how the site heals, you may or may not be a candidate for a dental implant due to the longevity of this infection. But at least you won't be dealing with an infection any longer.

I know this is difficult to comprehend..... and you don't want to lose your tooth. It is most important that you think carefully and weigh out the health risks of holding onto this infected tooth as opposed to getting rid of this infection once and for all.

I wish you all the best. I have informed you to the best of my ability. The choice is yours....

Bryanna