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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 6015
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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Looooooong story short.....Apicoectomy in tooth 13 (upper

Customer Question

Looooooong story short.....Apicoectomy in tooth 13? (upper left) 4 -5 months ago after chronic pain in area for 2 years which i wasn't sure was the sinus or a tooth that had been endodontically treated.. In those same two years I had complete sinus surgery TWICE (horrible sinus history) with pain mostly in the left maxillary sinus..... The same endodontist did the original root canal on tooth 13 and 14, both single rooted teeth, very straight forward. I went to a horrible new dentist at that time who handled the crown afterward. One issue after another, crown cracked, then temporary kept falling out etc...just disaster. I went to a second dentist who removed her crown and put too large of a crown in after anesthetizing me and tooth 13 pushed over the adjacent tooth and caused the peridontal ligament to stretch where the tooth was very loose at first but then tightened up, unbelievable!!! I eventually went to a third dentist who removed crown #2 and put in a propper gold post and a proper crown. She said the tooth was not fractured. This tooth has always had issues but so did my sinuses. Anyway, finally 4 mos ago after living in almost a chronic state of pain that was always worse at night, the left side of my face swelled up like a watermelon which lead me back to the original endo and the apeoectomy. The endo was very clear and stated that the original bad dentist had allowed bacteria to infect the area. (I save everything and brought him the original x-ray). Two years later there was FINALLY evidence of an infection above the root of the tooth on an X-ray(large dark area on the x-ray. ..............Now, 4 months after apico, the pain is just not really getting better. It is horrible again at night too. I went back 2 1/2 months ago and the ebdo kind of brushed me off saying it could take !* MONTHS????? for bone to grow back? He scraped alot of bone. And there were hundreds of nerve endings there and that it was very close to the sinuses and to give it time. My question is just how much time should I give this? Most info on the internet says people are better in a couple of weeks. This has been 4 1/2 months!!!! I'm ready to pull the tooth. I am just desperate. I also just completed two years of 2 impkants through a university and I am out of money. Now if I do pull this tooth will I be out of pain?? Your professional ideas on this would be sooo appreciated. Thank you very much.
Submitted: 5 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 5 years ago.
Welcome to JustAnswer, and thank you for putting your trust in me!

I agree that most pain originating from a chronic dental infection would have cleared promptly after an apicoectomy. Pain that persists a full 4-5 months after the apicoectomy suggests that something is amiss, and the apico did nothing to address the problem. Additional waiting is unlikely to provide any benefit at this point-- what you need is a good diagnostician to clarify the source of your pain.

While I am not generally pessimistic in nature, I'm uncertain whether tooth #13 is to blame, but it has clearly been through the mill and must remain a suspect. Not all apicoectomies are successful, and there are other possible issues-- for example, a fractured root-- for which an apicoectomy would provide no benefit. The removal of the tooth would be a leap of faith in the absence of any clear diagnostic indicators; even if it is extracted, the pain might remain, but that would in itself be diagnostically significant.

The two other possible suspects that must be considered is (a) a persistence of your chronic sinusitis, or (b) chronic neuropathic pain. As a dentist, I am unqualified to provide specific guidance, other than to say the proper follow-up by an appropriate clinician is crucial. Chronic sinus disease is notorious for is refractory nature, and must be considered a prime suspect. In addition, there are neuropathic pain syndromes (e.g., chronic regional pain syndrome/reflex sympathetic dystrophy) that are known to be associated with prior surgical interventions, such as your sinus procedures and apicoectomy. Proper assessment should include a consultation with a neurologist.

It may even be worthy to consult with these medical specialists prior to taking any action on tooth #13, if only to possibly avert an unnecessary extraction.

Hope this helps...
Customer: replied 5 years ago.
Definately do not have a sinus infection. I just had a sinus cat scan yesterday. The swelling on the left side is now evident. and i'm taking motrin too much. In the last week the pain/swelling just got worse. The endo with his microscopes and purple dye said there was no fracture.So, it is not fractured and I do not have sinusitis. I went to the best ENT in Chicago. I really don't think there is any neurologic issue. The ENT confirmed that it would be more like electroshock if there was trigeminal neuralgia which I do not have. ....He felt the kind of pain I described was from the bone infection.....Now, is there such a thing as a peridontal ligament abcess or damage??? that cannot be seen in an apicoectomy procedure??? (from the 2nd dentist stretching it so extremely). No other dentist seems to take that point too seriously, but when it happened it felt pretty exreme. I mean it pushed all of the teeth over. Luckily the original bad dentist put in a rediculously short post that went below the bone line allowing the tooth to be pushed in the tight space..... I guess I am still hoping this will get better and my tooth which I've spent almost $8000 on will be saved. I just made an appointment for Monday with the same endo. I just hope he doesn't brush me off and is straight with me. Either the large area of bone is still healing, or it will need to be pulled. The surgery seemed to go so well. Why is not healing?? Maybe he should have put in a bone graft like so many other people I have read about? I am just sooo frustrated and have been through enough. I should have pulled this a long time ago and put in an implant. Thanks

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