Apicoectomy

I have a tooth saga.  It's long and it's expensive and it's not over.  I was going to wait until it was over, but I'm not sure when that's going to be so I'm just going to write about it up to now.

There are several teeth in need of attention in my mouth, but this was the one we started with.  The filling was old and the additional decay enough that it merited a crown, so my dentist (who is also my neighbor) put on a temporary crown.  We didn't know if it would need a root canal, so we thought we'd start with the crown first.

After a day it was obvious that the crown didn't remove the discomfort so I went back in for a root canal.  And that's when things got interesting.  During a root canal, the dentist drills down into the tooth to expose the channels in the roots that contain the nerves.  Then he proceed to use these little tiny files to remove (or obliterate) the nerve, blood supply and any other tissues in the roots themselves.  He fills in the void with a metal filler and through some neat technology melts it to fill in the root canal itself.  If all goes well, at that point you should be pain-free in the tooth because it's hard to have pain in a tooth when there are no nerves to feel the pain.

In the middle of the procedure, my dentist takes little low-level x-rays of the tooth with these mini-files inserted down the root channels.  He does so to make sure he's removed all the material and has gotten the files to the bottom of the root.  All was going well until one x-ray showed his file going out the side of one root at a very uncomfortable angle.  He said immediately that he needed to send me to an Endodontist and he knew the best one in the area.   I found out later he was worried he had done something wrong or would have an angry patient.  But honestly, teeth are the strongest parts of our entire body, he couldn't have pushed a little dinky bendable file out the side of the root unless something were wrong, so I was fine with my dentist.  My tooth, I was annoyed at.

Let's keep count here, because that's root canal one.  And I was in pain now.  The endodontist took a 3-D CT of the tooth and it showed I had a resorptive defect, meaning at some point, possibly many many years ago, the root was under stress or pressure and partially re-absorbed into the jawbone.  He likened it to being moth-ridden.  His suggestion was for one of two options:  1) remove the tooth and plant an implant screw, for future implantation in six months to a year or 2) complete the root canal and do an apicoectomy on the root with the issue, meaning cut off the bad part of the root and remove any nerve associated with it.

The cost was similar (costly) but he said I could always go to an implant in the future and to know that a percentage of implants fail and if that happens, there is no alternative.  So I went for the tooth surgery, the more conservative route and possibly, he said, all the treatment I'll ever need on the tooth.

I scheduled the root canal and he said he'd try to do the apicoectomy on the same visit but it might not happen, depending on how difficult the root canal would be.  At that point I'm in pain so he gives me pain medication for the discomfort because the first root canal stirred things up.  He was running very behind schedule due to an emergency (and I don't argue with emergencies because some day it might be my emergency) but we got started eventually.

He chased down the canals and found an additional calcified one and worked late into the evening, close to eight o'clock, before he called it for the night.  Root canal two left me with a still-incomplete root canal and a still painful tooth.  And his calendar is full, but he is great at what he does so I got on the schedule when I could and took more pain medication for my throbbing mouth and waited.

Root canal three just happened to find him with another emergency surgery, this time on another endodontist.  I overheard from my chair at the end that he absolutely refused to let the man pay because he was a colleague from another town.  What a nice guy.   Back to my root canal number three.  This time he finished and he did the apicoectomy next.

Did I mention what happens in an apicoectomy?  It doesn't sound fun.  You can skip this paragraph if you don't like medical descriptions.  They have to enter your jaw from the side of your mouth and to do so, they have to cut into and lift up a flap of your gums.  And by lift, I mean physically scrape it off your jaw because your gums are well-affixed.  Then he drills a hole in your jaw bone and removes the root with some special endodontist tricks I can only imagine via the sounds I heard while it happened.

I did get pictures to take home and scare my friends with though.  A week later and I'm back for a checkup and it's still painful.  Not the gum incision, pressure on the tooth.  Strange, it should be feeling better.  Come back in two weeks.  Okay.

Two weeks later (today) and I can't even tell I had mouth surgery.  The tooth isn't throbbing, but it's not comfortable and I can't chew on it still.  So he took another CT and we reviewed it.  There is a root that has an unusually sharp curve in it.  He couldn't get his tool down it and he can't drill in a curved line, but it appeared to be completely calcified so he hoped it was nerve-free.  His suggestion is to let it heal for another month and then we'll make a decision on the next step.

His option is to go in an remove part of that second root.  It's not ideal, because it's another point of stability for that tooth I'd lose, but it would be at the tip of the root and he thinks there's a high likelihood I'll keep the tooth unless it cracks due to other reasons in the future.   If that doesn't work, he said he'd remove the tooth.  Me?  I'm hoping it calms down in few weeks and the pain is ligament-related around the tooth.

So for now I have an un-crowned tooth that's in limbo.  The endodontist said it's completely safe to be in this state as the channels are filled with solid material and he's done a bigger than normal build-up on the base.  But it feels strange and stump-like though.

I hope the other teeth aren't this difficult.

The Big Boy Update:  Super-Bat-Tiger-Man.  To school today (it's Halloween) he wore a Superman shirt under his tiger costume and his Batman shoes.  Tonight he is wearing his Spider-man costume.

The Tiny Girl Chronicles:   Super Reese.  She emphatically does not want to be a princess.  She has a dress-costume with the Superman 'S' on it and she calls herself, "Super Reese".  She wore it to school and will trick-or-treat in it tonight.  

Sickness Update:  Better.  Almost normal even.  I think I'm over the funk.  Just in time too as the marathon is in less than three days.