Root canal redo in postgrad endo clinic

[groundhog]

I'm in the process of having a root canal redone in the endo post grad clinic (chronic draining puss pocket which I have kept under control during my personal dental hygiene each day). The post grad thought at first that I might have a fractured root and would need a root amputation after a refill of the canals. Now he suspects a possible perforation happened on the first endo job but will not know for sure until the suspect root is fully exposed. Anyway the next step is to refill the canals using a cement type substance on the suspect canal. The exploration and amputation will follow a week later. When I became aware of the possible perforation I asked him if it would be possilbe to cut the root just above the perforation and thus save as much of the root as possible. He said yes and that a perforation can even be patched under the right conditions. Well he was originally going to refill the suspect canal with MTA but the Atttending gave him some static about the hygienic compatability of MTA vs another substance that the Attending seemed to prefer. Listening to the conversation between the PGY 2 and the Attending I sensed that the PGY 2 preferred to use the MTA because of the greater ability to be able to completely fill and compact the suspect canal with the MTA. Now that makes sense to me especially if a perforation is the problem and it can be patched or results in the minimum amount of root needing to be amputated. I'm now concerned that the Attending may overrule the PGY 2 when it would not be in my best interest. I'm now thinking we should hold up a minute and open up the root for exploration before any decision is made about the treatment of that root. What do you guys think? Should I speak up before the next appointment?

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[Blue Tooth]

Well as the patient, the final call on what procedure is done is yours, not the resident or the attendings. But all I can think of is why on earth are you going to go through a root amp? If that's what is called for, get the thing pulled and slam an implant in.

 

[LordLister]

It sounds as if this tooth has a poor prognosis. Why not extract the tooth and place an implant.

 

[groundhog]

1: The suspect root is the front outside root on the upper molar which still leaves the other outside root and the big inside root in tact for support.

2: The crown remains in tact after exposing the canals and only needs to be repatched with amalgam which will be replaced with a gold inlay at minimal cost in the near future.

3: I would likley need a sinus lift for the implant and I am already scheduled in four weeks for that exact same procedure in preparation for an upper molar implant on the other side of my face.

The extraction/implant was an option that I serioulsy considered , but I opted for the refill/amputation in this particular case. It was a jump ball for me. Hope I tipped it to the right team.

 

[groundhog]

Update
Today, the exploration was done (first). Found neither a fracture nor a perforation, but rather a gaping hole into the canal near the apex due to reabsorbtion of the root. Repair was not possible so the root was amputated. Went smooth as silk. Have not needed to take any post op meds to control pain which is suprising to me given the flap pullbacks, root sectioning/extraction, bone refining etc.

Anyway the root reabsorbtion news tweaked my memory about the tooth's history and is a good lesson in the importance of attending to matters in a timely manner. Many years ago a pin was placed into the tooth to support a deep amalgam filling. I felt an electric twinge deep in the tooth when the pin was placed but thought nothing of it nor said anything to the dentist. A year or so later I suffered though three days of intense pain in that tooth. Again I did not contact my dentist regarding the matter. A few years later I suddenly developed a painful swelling in the gum tisssue just above that tooth. This time, I went to the dentist and he punched a hole in the gum which relieved the swelling. I then discovered that I was able to daily massage the area that had been punched in order to continusly drain the infection and prevent a reoccurance of the painful swelling. So, again I did not seek any further assistance from the dentsist regarding this matter. Five or six years later some decay developed around the deep amalgam filling and I was informed that I needed a crown plus a root canal because the root was dead. I then had the root canal and crown done. The Endo told me that he thought the infection should clear but to report back to him in three or four months if it did not. Well the infection returned but I did nothing except to continue my massage routine over the next three years. That brings us to today with the resulting redo of the root canal and a root amputatiion.

What was my excuse? None really. I've always had good dental insurance, went for regular checkups, and I have no dental fears. I think it was just my lame sense of thought that problems will go away in time...be tough and don't complain...no news is good news etc. Anyway, learn from my mistakes.

 

[mike3kgt]

Update
Today, the exploration was done (first). Found neither a fracture nor a perforation, but rather a gaping hole into the canal near the apex due to reabsorbtion of the root. Repair was not possible so the root was amputated. Went smooth as silk. Have not needed to take any post op meds to control pain which is suprising to me given the flap pullbacks, root sectioning/extraction, bone refining etc.

Anyway the root reabsorbtion news tweaked my memory about the tooth's history and is a good lesson in the importance of attending to matters in a timely manner. Many years ago a pin was placed into the tooth to support a deep amalgam filling. I felt an electric twinge deep in the tooth when the pin was placed but thought nothing of it nor said anything to the dentist. A year or so later I suffered though three days of intense pain in that tooth. Again I did not contact my dentist regarding the matter. A few years later I suddenly developed a painful swelling in the gum tisssue just above that tooth. This time, I went to the dentist and he punched a hole in the gum which relieved the swelling. I then discovered that I was able to daily massage the area that had been punched in order to continusly drain the infection and prevent a reoccurance of the painful swelling. So, again I did not seek any further assistance from the dentsist regarding this matter. Five or six years later some decay developed around the deep amalgam filling and I was informed that I needed a crown plus a root canal because the root was dead. I then had the root canal and crown done. The Endo told me that he thought the infection should clear but to report back to him in three or four months if it did not. Well the infection returned but I did nothing except to continue my massage routine over the next three years. That brings us to today with the resulting redo of the root canal and a root amputatiion.

What was my excuse? None really. I've always had good dental insurance, went for regular checkups, and I have no dental fears. I think it was just my lame sense of thought that problems will go away in time...be tough and don't complain...no news is good news etc. Anyway, learn from my mistakes.

Sounds like dentistry to me. If everybody was ultra-meticulous about hygiene and visited dentists reguarly without thought.... it's possible we may be out of a job!

Speaking of which, I need to go see somebody about my cracked #30... ah well, I'll keep popping it back into place with my tongue until I need an implant!

Muahaha,
-Mike