Second apicectomy or implant?

[Airelle]

Hello,

I went to see my dentist today to discuss having an implant on my left lateral incisor tooth. Here is a little big of background:

- I have a crown on this tooth but the tooth inside the crown snapped broken a year and a half ago and I needed to have a stud drilled in and a new crown put on (the root wasn't removed). This tooth was already dead as I had had root canal treatment on it several years back.
- December 2007 I had severe pain in the tooth and the dentist discovered that I had a cyst on the tooth root tip and had to do an apicectomy.
- In October 2008 I noticed swelling again on the tooth (gum) and went back to the dentist, who said that I might need to have a second apicectomy or the tooth extracted, but we decided not to do it yet as the swelling was not too bad (and I had no pain).

Couple of weeks ago the swelling on the gum started to get bigger and so today I went to the dentist again, he took an x-ray and saw that the new infection is now bigger than the initial cyst.

He said that we could do a second apicectomy, but the success rate of the second apicectomy is not as high as the first. From internet, I have seen that the success rate of first apicectomy is about 75%. My dentist did mention that a tooth extraction and an implant would guarantee a better (long-term) success.

My question is:

- What is the success rate of second apicectomy (in terms of percentage)?
- What is the success rate of a tooth implant (in percentage)?

I'm not sure whether I should try a second apicectomy and hope it works, or get the implant. What I don't want is the bone tissue infection spreading and infecting other tooths. I understand this risk remains with a second apicectomy, but is it completely removed by extracting the tooth and putting in an implant?

I would really appreciate your opinion on this, as I think its good to get second opinion from another dentist as well!

Thanks for your help in advance.

[Dr Sepehrara]

Hi

Of course the percentage success rate goes down on repeated apicectomies. Also each time you have an apicectomy you are removing bone which would be valuable in implant placement. Of course if a patient wishes an implant and there is not enough bone , then they would require an additional bone graft. It is impossible to give a percentage because each case has different circumstances.


We see many patients in these circumstances and we normally recommend an implant , as this would have a better success rate. Of course each case is individual and there are many factors to be taken into account.

My best advice would be to get a second opinion face to face, allowing the dentist to carry out a full clinical and radiographical examination. It is very difficult to answer your questions without carrying out these examinations.

I hope this helps

[Airelle]

Thank you very much for your quick answer Dr Sepehrara! I think I will get the implant, as it is the better long term option.

I have another quick question, my dentist mentioned a 2-year warranty for the implant, is this quite common in the UK? Or should I try to find another dentist who can offer a longer warranty? I know in some other European countries the warranty can be up to 5 years.

Thank you again.

[Dr Sepehrara]

Hi

Guarantees vary in different practices. Majority of guarantees are dependable on 6 monthly visits to the same dentist, to allow maintenance. Maintenance is very important for good long term prognosis

I would strongly recommend seeing a dentist who places many dental implants and has adequate postgraduate qualifications.

[Airelle]

Hello Dr Sepehrara,

Thank you again for your reply. I was able to get in contact with my dentist today and ask some questions, and found out that he doesn't have a postgraduate degree, but apparently he has the certificate from Branemark Institute and has been doing implants for the past 5 years. He also works in a hospital, specialising in compromised patients (with cancer etc). He is also a member of the Royal College of Surgeons.

The price that he has given me for 1 implant is a bit cheaper than what I have seen on other dentists' websites, and because him and his colleague have treated the initial apicectomy I'm inclined to go with this dentist.

What would you recommend in this case?

Thank you again so much for your help!

[Nilesh]

Hello,

I went to see my dentist today to discuss having an implant on my left lateral incisor tooth. Here is a little big of background:

- I have a crown on this tooth but the tooth inside the crown snapped broken a year and a half ago and I needed to have a stud drilled in and a new crown put on (the root wasn't removed). This tooth was already dead as I had had root canal treatment on it several years back.
- December 2007 I had severe pain in the tooth and the dentist discovered that I had a cyst on the tooth root tip and had to do an apicectomy.
- In October 2008 I noticed swelling again on the tooth (gum) and went back to the dentist, who said that I might need to have a second apicectomy or the tooth extracted, but we decided not to do it yet as the swelling was not too bad (and I had no pain).

Couple of weeks ago the swelling on the gum started to get bigger and so today I went to the dentist again, he took an x-ray and saw that the new infection is now bigger than the initial cyst.

He said that we could do a second apicectomy, but the success rate of the second apicectomy is not as high as the first. From internet, I have seen that the success rate of first apicectomy is about 75%. My dentist did mention that a tooth extraction and an implant would guarantee a better (long-term) success.

My question is:

- What is the success rate of second apicectomy (in terms of percentage)?
- What is the success rate of a tooth implant (in percentage)?

I'm not sure whether I should try a second apicectomy and hope it works, or get the implant. What I don't want is the bone tissue infection spreading and infecting other tooths. I understand this risk remains with a second apicectomy, but is it completely removed by extracting the tooth and putting in an implant?

I would really appreciate your opinion on this, as I think its good to get second opinion from another dentist as well!

Thanks for your help in advance.

Dear Airelle,

The current success rates for a repeat apicectomy currently stands at 35% (Persson et al, I forget the date, i think it was published in 1973). the success rates of a first time round apicectomy is 82.5% (this is quoted as an average value of several studies).

To be honest, I probably wouldnt even have attempted the apicectomy the first time round as the success rate is worse then that of a single unit implant (95-98%). Furthermore, to actually gain access to the tip of your tooth to perform the apicectomy some bone needs to be removed which is exactly the opposite to what an implantologist wants!

With regards to guarantees, I give all my patients a 5 year guarantee as long as they see me twice a year and see my lovely hygienist twice a year as well. As already pointed out, implants need maintenance! If you bought a ferrari, it needs to go in the shop every year for a tune up! Same for your implant!

As for postgraduate qualifications, there is (in my opinion) very poor regulation in this country of dentists who place implants. A vast majority of the implant placing dentists in the UK have not had or achieved any formal, recognised implant qualifications in implant dentistry. The certificates/diplomas etc can all sound very impressive but can amount to nothing more then the dentist paying X amount of money, sitting on a course for 2 days and recieving their certificates. I would always recommed a dentist with recognised post-graduate University awarded qualifications in Implant dentistry.

As for price.. in the region of £2000-£3000 is reasonable.

Hope my rambling has been of some help!

[Airelle]

Hello Dr Nilesh, and thank you for your reply! I went to see another dentist today, who has been doing implants for over 20 years, and decided to go with him. The price that he has given is also £900 more expensive than my first dentist, but I say to myself that in matters like this I should look at the overall picture and not the price...

Thank you again for your help!

[Nilesh]

Hello Dr Nilesh, and thank you for your reply! I went to see another dentist today, who has been doing implants for over 20 years, and decided to go with him. The price that he has given is also £900 more expensive than my first dentist, but I say to myself that in matters like this I should look at the overall picture and not the price...

Thank you again for your help!

My pleasure, I hope you get things sorted out as soon as possible