This case illustrates an attempt to preserve a natural tooth through apicoectomy, retrograde filling, and bone grafting, after retreatment of a root canal failed to resolve a large and deep periapical lesion on an anterior bridge abutment tooth.
Dentist in Charge Sungmin Ko Chief Director
The anterior tooth, which had undergone root canal treatment and bridge placement, exhibited dull pain and recurrent gum inflammation. Radiographs revealed a large and deep periapical lesion around the root tip.
First, the tooth's interior was cleaned through retreatment. Then, the gum was opened to remove inflamed tissue and approximately 3mm of the root tip, followed by retrograde filling with an MTA-based material. Bone grafting was also performed in the area of bone loss.
After retreatment, an apicoectomy was planned to remove the periapical lesion, followed by retrograde filling and bone grafting, and then suturing. Currently, a temporary crown is in place, and bone healing is being observed.
The periapical lesion has been removed, and the root end has been retrofilled. The healing process of the bone graft site is being monitored with a temporary crown.
Treatment Details
Hello, I am Dr. Sungmin Ko, the chief director of Seoul Yido Dental Clinic. Since opening the clinic, it feels like time has flown by with preparations, treatments, seminars, and conferences.
Nevertheless, it has already been two months since we opened! First and foremost, I want to express my sincere gratitude to everyone who has trusted us and visited our clinic.
This is the waiting area of our Mapo Dental Clinic, Seoul Yido Dental Clinic. Every day, we meet various patients and listen to their concerns, and we strive to grow day by day to provide better solutions to those concerns.
However, there's one thing... I have some unsaid words and explanations for our patients that remain on my mind. So, starting today, I will diligently try to document them on this blog!
I was wondering what topic to choose, and decided to start with "natural tooth preservation"! Why does it hurt after a root canal? Mapo Dental Clinic: "Doctor, this is a tooth that had a root canal years ago." A tooth that had a root canal a few years ago and was beautifully crowned...
...starts to ache one day, and sometimes a pimple-like bump appears and disappears on the gums. Has anyone reading this thought, "Oh, that's me too"?
Root canal treatment, which we are all familiar with, is simply cleaning the 'inside' of the tooth.
However, the root tip is much more complex than one might think. I often use images like these to explain it, but in reality, it's not just one main canal like these simple images suggest; there are fine, branch-like canals extending sideways.
Sometimes, bacteria hidden there leave inflammation in the bone at the root tip. Can a tooth be saved with apicoectomy if the inflammation isn't resolved by retreatment? At Mapo Dental Clinic, retreatment is usually recommended first in such cases.
This involves reopening the inside of the root, meticulously disinfecting it again, and refilling it. Most cases improve with this, but sometimes the inflammation deep within the bone is beyond reach.
And there are cases where the prognosis after retreatment is somewhat disappointing. That's when apicoectomy is considered. Apicoectomy...! The name sounds a bit scary, doesn't it? We open the gum slightly, thoroughly scrape out the inflamed tissue at the root tip, and then cut off about 3mm of the root tip where bacteria were hiding.
Then, the cut end is sealed with a strong material, and the gum is sutured.
Partynia/Wikimedia Commons, CC BY-SA 4.0 Most of those fine side branches are concentrated within the 3mm of the root tip.
So, we try to preserve as much of the tooth as possible, only removing the problematic parts. "Will surgery hurt a lot?" You're probably curious about this too, right? Haha. We proceed with anesthesia, so you won't feel much discomfort during the treatment. Afterwards, you might experience some swelling or aching for a few days.
Nowadays, with magnifying equipment and CT scans, we can perform it much more precisely, and success rates of up to 90% are reported for precisely performed cases. The results have definitely improved compared to older methods.
This tooth was an abutment tooth supporting an anterior bridge.
It's a structure where the two adjacent teeth support a three-unit anterior bridge like a bridge.
Upon checking the X-ray, a large inflammation is present. Just a moment, which option would you choose? ① Extract both abutment teeth and replace all anterior teeth with implants. ② Try to save your natural teeth, even if it takes some time.
The answer is, "We need to assess the tooth's condition," but in this case, both posts had sufficient root length and surrounding bone to support them.
Therefore, option ② was chosen.
Mapo Dental Clinic after retreatment. So, first, the inside was cleaned with retreatment.
For the left anterior tooth, which had a large and deep inflammation around the root tip, an apicoectomy was planned.
Retrograde filling during apicoectomy (reference image) Uoykcuf / Wikimedia Commons, CC BY-SA 3.0 After root resection, the area is meticulously sealed with biocompatible materials like MTA.
This is called retrograde filling. To put it more simply, if root canal treatment fills the tooth from top to bottom, retrograde filling fills it from the root tip upwards. It is also the most meticulously performed step in apicoectomy.
This is a photo after apicoectomy and retrograde filling. The root tip is indeed shorter, isn't it? After removing the inflamed tissue at the root tip, bone grafting was also performed in the area of bone loss.
The bone around the resected area will slowly regenerate over several months, so we are currently observing the healing process with a temporary crown.
We also create temporary crowns with aesthetics in mind. We'll be sure to share the follow-up story once the treatment is complete! As you read this, you might be thinking, wouldn't it be cleaner for the patient to just extract it and get a new one?
As someone who sees the beginning and end of a single tooth, from root canal treatment to prosthetics and implants, I often ponder this thought.
“No matter how good implants become, they cannot perfectly replace your natural teeth!” And once a tooth is extracted, it doesn't come back, does it? If there's a possibility to save it, we thoroughly evaluate that option first, and then we discuss implants.
It's still not too late. (Of course, if there's a vertical crack in the root, too much bone loss, or if the remaining root is too short, extraction might be the better option.) Apicoectomy, before extraction, one more time at Mapo Dental: "My root-canaled tooth hurts again."
“I was told elsewhere that it needs to be extracted.” “I want to save my natural tooth.” If you have these concerns, I hope you'll check one more time if there's a way to save it before making a decision.
Because our teeth are truly precious!
I think I'll conclude here for today. Thank you for reading to the end, haha. Please continue to show a lot of interest in our blog ^^ This was Chief Director Ko Seongmin. Thank you.
※ Temporary swelling, pain, bruising, or altered sensation may occur after apicoectomy, and regular follow-up observation is necessary.
2nd Floor, 24 Mallijae-ro, Mapo-gu, Seoul
Please check before treatment
Temporary swelling, pain, bleeding, bruising, infection, or altered sensation may occur after an apicoectomy. The prognosis may vary depending on factors such as tooth cracks, remaining root length, and the extent of bone loss. If symptoms persist or recur, additional treatment or extraction may be necessary, requiring regular follow-up observations.
View Clinical Cases
Enter simple information to view cases
Search anything
Ex: Implants, swollen gums, teeth whitening
