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Can anybody tell me what apicoectomy success rate is? My dentist recommended apicoectomy as a surgical procedure to try to save my toot. I am going to have apicoectomy five days from now. I am 33 year old, male. This is the first time that I will do this kind of procedure. I am worried because everyone has different story and opinion about how successful is apicoectomy.

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Hey I don’t have experience, but I can tell what I read somewhere on web about it. It says that filling materials and the operation method were considered to be the most important factors for a successful outcome. According to this the success rate of apicoectomy with orthograde filling or apicoectomy with retrograde gutta-percha root filling was significantly higher than that with retrograde sponge gold filling. A four months after operation, it is possible to determine whether or not apicoectomy is successful. Bone reconstruction was found to start from the periphery of the bone cavity. The bone defect became gradually reduced in a star-like pattern and four months after operation, in the successful cases, the area of bone cavity decreased 46-64%. In the unsuccessful cases, the area did not change or increased 75-120%.
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I have had Apicoectomy twice on the same tooth and now I'm having trouble with it again. All this after RCT and crown. It certainly hasn't been successful for me. Not sure if it's the procedure or the dentist that is a failure.
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Great success rate if you have a right doctor. I had few epicos about 15 years ago, with no guarantees, that is not good prognosis due to short roots I have. They lasted 15 years! it was worth every penny.
Now I have a problem with one of them, ( after 15 years) and have a hard time to find a surgeon to redo it- they all prefer extraction and implants, etc, and are not that conservative like the docs I had who retired by now.
This is a new era of implantns, however, bear in mind that no implant can replace your own bone and root, even dead root is better than implants. Of course, this is my personal opinion.Each case is different.
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I had a failed second root canal retreatment on tooth #3.  There was a lingering infection there that just wouldn't go away for weeks, despite antibiotics (that shread my gut (hello yeast infection)).  In addition having an ondodontist who works for your general dentist office only on Fridays (or similar one day only a week) are definately something you MUST find out about before you even decide to continue with that dental office.  Why? Because they'll be giving you the appointments 2-3 Fridays away - and if you have an infections - good luck.  Also remember one more little nasty thing: if your general dentist recommends his endodontist - you MUST yet again make sure that that endodontist IS IN YOUR Network.  As far as the procedures- no guarantees contract is basicaly forced upon patients no matter what.  Your choices are walk away with the infection or sign your life off, and that includes having to sign that you understand that due to errors (incompetent inexperienced dentists) you agree to pay in full even if your tooth ends up being extracted, or if you end up with a life long loss sensitivity in the area of the thongue, cheek, or lip due to nerve damages.  When all of it fails (root canal, or retreatment) - like it happened to me - you are looking into 2 choices:  Extraction or Apico.

I sat on the dentists chair two days ago.  I decided on the extraction already as I read the Apico success rates range from %60-%90.  Before a ended up on the chair inside a maxillofacial surgeon office I've seen exactly two more endodontists and one more general dentist (in addition to gen dentist and endodontists who had screwed up the recanalling)  Here are the facts:  the endodontist #1 at Central Park South didn't recommend Apico and told me he in fact stopped doing those (why I'll never know).   He did recommend redoing the root canal for infection.  The endodontist #2 at Lower East Side 5 weeks later took a look at an exray of the same tooth (after the incompetent endo started the re-root canall on it) and told me right away the tooth is gone and I need to do extraction.  I asked about Apico and he said "no" and the success rate of Apico is only 60%.  Now as I was sitting at maxillofacial surgeon chare all decided on the extracion the surgeon first came and pushed stronly for the Apico.  I asked him what his expected success rate was and the quickly answered %90!  Meanwhile 45 minutes prior to that conversation I've HAD to sign a contract saying I understand all the risks and will pay IN FULL for all the failures of the procedures including broken jaws, lost sensitivity in tongue, cheek or lip areas possibly for life and such. - Back to the conversation - so I then asked the surgeon while sitting in the chair if he could guarantee this %90 success and he said nothing could be guaranteed.  So frankly to me it all is just a sale.  Patient's consumer rights here are out of window: your only choices are again pay and sign up for any loss in advance or become a walking infection body.   Few minutes later I asked this surgeon's very nurse what she thought the Apico success rate was and she said %50-%50!!!

 

While I was thinking about this the surgeon said he had to visit another patient (time is money) so consulted with my friend who was waiting for me in the waiting room. 30 minutes later the surgeon is back in my room and he now has a new sales pitch that no one mentioned to me yet nor did I in my wildest dreams expect would come to me at that moment.  Basically his next strategy was push for an implant, and with a very good reason.  Turns out one of the two things may happen when you extract the tooth:  either you'll just extract it and let the bone sink in naturally as the bone around where the tooth roots used to be - called sockets - will simply even down and decrease in hight.  OR you can extract the tooth and immediately start with the bone grafting thus preparing it for an implant at some future time (that should be within 2 years from grafting or the graft will also deminish with time)  The financial slap in the face is also heavy with eather choice.  If you just extract the tooh ($300 with my insurance) it will cost almost $2700 out of pocket later to do the bone grafting later because the gums around the extracted tooth will build a tissue over the bone and will require more work and money to graft later.  The cost of doing it at a time of extraction is only $700 ouf of pocket because the access to jaw bone is open to inseart fresh cadeavor bone tissue.  This apprently is better choice even if you've had a persistent infection at your roots (which is a reason for an extraction anyway) because once the tooth is extracted the infection can apperently be killed by checimals within seconds IN FULL.. thus granting access to safe bone grafting.  

 

So I came to the office with the decision to only extract the tooth and try Snap On Smile just for fun till I decide what to do about the gap from #3 extraction.  Instead I walked out with extracted tooth and a bone graft and ordered flexible flipper to serve as a temporary fix till my implant is done.  I wish someone of so many dentists I've seen could lead me by the hand through the whole process including the risks, long term benefits, costs etc... but I find both general dentists and specialists are in it for the profit and while some will give you usefull info often it is clouded by their own motives for profit which is easy to see through and by their own lack of knowledge when it comes to looking at the whole system - which is a much harder hit.  Why do I say that? Here's why:  I've done and read and studdied all of this before making any decisions and I foudn that in fact doing any sort of a bridge and thus ruining or capping two teeth on the side of the missing tooth will in the long term (30-40 years) ALWAYS cost you more than a single implant.  At first is seems like an implant is roughly just under $5K so that's scary. ( Note: currently as of today -September 15 2012 most insurances are NOT covering implants).  However these $5K may last 30 years where's a bridge on average will rut and decay and require some form of alteration on average every 6 years, including having to root canal the feet of the bridge eventually as they will give in slowly. So again implant seems a better sollution.  

Another thing you wont hear much about is mini implants.  They cost half from the full implants but the reviews are controversion like almost everything else.  Check few at http://www.realself.com/question/mini-dental-implants-expert.  This btw is a great site to check patients experiences regarding everything on face of the Earth.  To save you time I'll just mention the final oppion I've formed from reading on mini implants is that they are primarily used for creating bridges in tootheless patients.  The history of mini implants is that they were used as a temporary fix while the normal size implants were being prepared.  While some dentists claim that a single mini implant can be used for a single tooth remake, it seems to me most dentists believe it will work but not for a life time like a real size implant.  Seems like you get what you pay for. But again in case you have few teeth missing looks like minis are cool... just youtube it.

 

Summary:  Apico - not worth it.  It's too hard to determine surgeons level of experience to double check his equipment, fillers etc and his state of mind.  No guarantees contracts enforce all the risk on your part and none on dentist's.  He could be rushing with you in order to catch a plain for his vocation and you're at risk.  My research settles on %60-90 success rate, again no guarantee.  Also you will find arguments about keeping necrotic teeth in your mouth being a chronic source of infections that are very hard to detect by xrays esp if your roots are dead.  You wont feel anything but the infection that will live in your jaw and between the apex or tip of the root canal and the sinus may thrive there for years and the bacterial extreetions may elevate risks to your heart as the blod circulates these extreections non stop.  Naturopaths and homeopatic dentists will stress this for you.  The pharmacy sponsored dentists will try to "save" it.  Yes there is nothing like your own tooth in your head even if dead for years (mine certainly function fine for 10 years) but there is a point when keeping the tooth doesn't make sense any longer esp when the dental jaw infection becomes a threat to wider area (lymph nodes, heart...)  Should you do implants - it's a risk only you can decide on.  There are flippers, flexible dnetures, partial singly tooh dentures, and ofcourse tissue regrowth from stem cells coming up but not yet commercialized as I write.  

Best of luck

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Your post was so helpful Alex, I recently had an apico and I'm still not ok, I'm hoping things will change but I'm a little worried, while going through this on tooth # 13, my dentist decides to take my old fillings out and cause me pain and now I needed another root canal on #3( oh and I forgot to mention he didnt even consult with me that he was taking out old fillings so now I have pain on both sides of my mouth, and I really feel this could have been totally avoided. I have full insurance that does not pay them all that much so I guess my treatment is obviously not going to be that good, ever since I started going to the dentists Ive had nothing but problems and I really want to shout it out, What ever happened to the code of wanting to help the patient and drop the greedy practice of how to make the most money out of a procedure. I think your choice of implant was the best choice, I'm still in pain and praying, so maybe my apico will take a few months to heal or I too will need an implant, good luck to you and all of us!!!
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I'm on my 3rd. Just had a re-treatment of the root canal..(first re-treatment) 3rd Apico. It's a front tooth, so I'm holding off on the implant since it's almost $5000

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I had tooth #14 root canaled 2x, 13 years ago...My first and only. The first one didn't work and became completely infected and painful within weeks, so I had it re-done. It just recently starting hurting me again, especially when I ate anything sweet. I saw my holistic dentist who suggested to have it removed, as the chance of ever truly getting rid of the infection is very slim, considering two failed root canals....I reluctently saw the oral surgeon just to discuss my options, but ended up leaving there with it pulled. Somehow, he scared me into thinking that apicoectomies only work 60% of the time and they don't really do them anymore when they can just pull the tooth, remove the infection completely and place an implant in a few months(convenient that this oral surgeon places implants). Well, I wish I would have seen someone else for another opinion. I really miss my tooth and I think it could have been saved! I know I made the wrong decision....and I'm scared to get the implant, but now I have no choice! Good luck to anyone in this situation....Please get a few opinions, people!

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I am in the failed root canal scenario. I had one performed by a dentist (not endodontist) 16 years ago. It bothered me from day one. But ignored the signs and it crowned. In any-case an apical abscess developed shortly some time later. I have lived with this abscess which used to abate with Amoxicillin however, the last several months the pain has become unbearable. I have spoken with two endodontists. Both are board certified, and actually sit on as board examiners. A dentist I saw nearly 10 years ago told me to get it removed. I did not and life went on with the discomfort. I also did not have the money for what would go in its place. The current endodontists want to do a retreatment root canal by drilling through the crown. Then watch and see. The abscess in the X Ray looks fairly large and is at the tip of the root of the tooth. The bottom part of the tooth is partially dissolved. The gum has receded quite a bit and the entire tooth appears to be black. I have asked so many dental professionals the questin as why it is black but no one answers it for me appropriately. Some say, its because of the infection. Others say its because its a "dead tooth." But the tooth itself looks solid and really, the poor thing is trying so hard! Its the first dentist who in fact messed it up. A piece of instrument is laying in one of the canals. The endos I have consulted with (over a hundred bucks for each consultation) tell me that the root canal was badly done. The canals weren't filled properly with the GP. Meanwhile my periodontist ( had an amazing sudden bout of bacterial attack after having a "cleaning" where my entire mouth was "scaled" (but not scaling and root planing), in a prophy type of a cleaning. The hygenist did not flush! She performed the scraping with no water flushing. But she did stick some paste and pretend to "polish" a bit. Apparently full mouth scaling is not the way to go - but thats a different discussion.

Back to my failed root canal, which is still festering in my mouth. Still totally confused as to what to do. But this can't go on much longer. My health has been effected by this root canal. Chronic fatigue, chronic pain, and now jaw pain.

My endo said that she wouldn't know if the root canal would be successful until she "opened" it up. But yes, I would still have to pay.

Root canal: 1,500
Apico: 2500
New crown: 1500 plus.

Prognosis: Who knows!

What to do?


My entire jaw hurts and lately I have been nauseous and have frequent headaches, even like I was going to faint.
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Catnipchimp,

Trust me, I feel for you and your dilema! Which tooth is it? I recommend seeing an oral surgeon,but not one that does implants, otherwisw they might be more inclined to push extraction and implant. See what they have to say, but come in with all your questions and concerns written down on paper so you dont forget anything! Don't wait too much longer though, if you feel sick from this infected root canal. Good luck and let me know what you decide.
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Tooth #30.

Got an appointment with the oral surgeon, but he is does implants.
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Catnipchimp,

I'm so curious to see what this oral surgeon has to say...Please let me know. Those first molars can be buggers!! Probably the most difficult teeth in the mouth to respond well to root canals. Well, if they push the extract with implant , what do you think you will do? All the best!
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Well, what I am hoping for is to get some understanding of what state the bone, both of the tooth as well as underneath, the jaw is in. What grade of the apical abscess is and if there is additional radiolucency extending further around the area.

I did some research on NCBI/Pub med. My understanding is that there is an algorithm that can assess the risk in order to provide a prognostic evaluation.

The retreatment of the root canal could be undertaken however, its the infection which is the concern. I've been reading that if an apicoectomy is performed with the erbium laser or with high tech instrumentation such as operating microscopes etc.the success rate increases dramatically. Then there is also the research which points to the use of 2% chlorhexidine gel mixed with calcium hydroxide as an intracanal anti-microbial medication. I have also been reading about TAP therapy for re-treatment root canals, but no endodontist I know is willing to use this paste made from 3 antibiotics which has been shown to cut infections and supports healing.

I gotta do something!
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Wow, you seem to have done your research! I'm glad you are well informed. I hope you get the answers to help you. Please keep me posted...
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What surprises me is that not one of the endodontists I have seen, including the periodontist as well as general dentists have even suggested that I should have the abscess drained. A simple procedure.

Here's a link that discusses it.

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May not be the complete solution but could help someone in pain from it!

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