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May 8, 2020
Is bone slow to heal? You bet.
This is always something I remind my patients and my referring dentists of: bone is slow to heal and regenerate after root canal therapy. So you must be patient when assessing healing of your root canals.
My typical recall protocol is to bring the patient back one year after treatment.
Here is a perfect example of a case just like that.
This tooth had normal probings, slight pain to percussion and no response to cold. The diagnosis was a Necrotic Pulp and Symptomatic Apical Periodontitis. It was a pretty straightforward root canal with no surprises along the way.
At the end of the procedure, when the patient is looking at the postoperative radiograph and they see that the radiolucency is still there, it’s always a good idea to remind the patient that the bone will start to regenerate from that point on.
Most people look at the radiolucency as the infection, when actually it is just a response to the infection that exists in the canals. So a quick, gentle reminder of what they are actually looking at here is always a good idea.
One year later, the patient looks like this…
You can see that there has been great resolution on the mesial root, but the distal root still has some healing to do.
This does not surprise me, since bone is just that slow to regenerate. In fact, I have had some teeth take a good 3-4 years to fully regrow their bone.
I am actually overjoyed when my recalls look like this, because my root canal is working. Don’t get disappointed if it is not totally healed because many times it won’t be complete at this recall. So, I like to follow the radiolucency until it disappears and I will see the patient in another year for another recall.
Be patient, because bone is slow
Keep this in mind when you are evaluating a new patient in your practice that may have a radiolucency associated with their tooth. Learn their dental history to make sure that the radiolucency is not something that is going away before you decide that that tooth is infected. It may be something that is actually healing.
So, when it comes to endodontic healing, give these teeth a chance to heal with some extra time.
What’s Your Endodontic Know-How?
-Sonia
15 Comments
Doc
Is the diagnosis ACUTE APICAL PERIODONTAL ABSCESS instead of ACUTE APICALPERIODONTITIS?
Thanks for the reminder..very informative
Superb information ma’am….
Good article and important to remember; I know I have sometimes got frustrated when 6 months later on recall I still see a radiolucency present. Bone is slow to heal, and good to know it might take a year or so before seeing progress. In your opinion, how long post-op should you begin to see a decrease and fading away of symptoms?
Thanks very much, Dr. Cummings!
-Sonia
I’m glad this was helpful for you.
-Sonia
Hi Praveen – the current AAE guidelines the diagnosis for this case is Necrotic Pulp and Symptomatic Apical Periodontitis. Please look back at my Pulpal and Periapical Diagnosis Guide Here: https://drsoniachopra.com/free-pulpal-and-periapical-diagnosis-checklist-funnel/
-Sonia
Hi Dr. Rowe – I don’t usually see any changes before 6 months. So make sure you wait that long.
-Sonia
Hi dr! I’m a patient & hope you can advise.Had RC on a FRONT tooth 13 mths ago ..infection a few weeks later & prescribed antibiotics.But,about 6 mths after having RC got lump approx.1” above tooth & infection which burst so back to endodentist …no X-ray taken & he said he thinks lump could be bone regrowth going a bit crazy…should make review appointment in 3 mths…but they’ve not contacted me & it’s been 5 mths now since I went to dentist.The lumps getting bigger & wonder if can be bone regeneration that’s got a bit out of control…can’t see a head on lump which thought might appear If was another infection or a type of cyst.I can not find any info about bone regeneration going out of control (& forming a big lump)after having RC or other traumatic dental treatment & wonder if you can tell me if this can be what’s happening or is it more likely an infection which may need retreatment or whatever.Lump isn’t painful altho can feel it as rubbing.Worried incase I should be seeking treatment.
Would very much appreciate any help! Kind regards,Jo
Hi doc! I realise I’m just a patient but hope you’ll help me.I had RC on front tooth 13 mths ago..infections returned twice…antibiotics first time but not second.Went back to endodentist after second & altho no xrays he thought the lump was just too much bone regenerating & didn’t seem worried.I told him I’d read that RC’s can take several years to completely heal & he agreed…said ok to wait & see.The lumps getting larger(marble size)& altho no pain it’s a little annoying as rubs on top lip.Cant see a “head” so not sure if it’s another infection.Have researched this matter but can not find any info about too much bone regenerating that produces a lump after RC/other traumatic dental procedures so don’t know if true.Can you tell me if you’ve either seen or heard of this happening or more likely it’s another infection or a cyst…I’m desparate as it’s a FRONT tooth & desperately want to save it if all possible…don’t want to leave it to late incase I could make things worse & treatment less likely to be successful.If you know about this issue then are these lumps self limiting in size or can they continue to grow..& can they become infected?
I would be so deeply grateful for any help…many thanks,Jo Kelly
Hi! Fourth email & no reply yet but maybe you don’t know answer to my question…will try again! Can you tell me if you can get bone regeneration after root canal treatment that grows a bit of control leaving a lump above the treated tooth 12 months after having rc? Or,do you think it’s more likely to be a cyst,abscess or infection…can’t see a “head” to say it’s an infection or abscess to make me think it’s going to burst…if you think it’s just bone regenerated or calcium then is it safe to leave…can it become infected or whatever? My Endodentist saw me & he thought lump was just bone where it’s gone a bit crazy & thought will be ok…but it’s getting bigger altho not really painful…just rubbing on underneath of top lip & can feel there’s a lump.
Many thanks,Jo Kelly
Josephine,
Unfortunately, I cannot make a proper diagnosis without completely evaluating you. Please feel free to look up an awesome endodontist in my free resources tab on my website. If you have more questions about your diagnosis, I suggest, you follow up with an endodontist.
-Sonia
Jo Kelly,
I don’t want to guide you incorrectly, and it is a bit difficult to answer you without imaging and me being able to clinically evaluate you. I have a free resources page of endodontists I love on my website. Perhaps one of them is in your area. I whole-heartedly trust them to be able to help you.
-Sonia
Tooth got impacted then I got a crown because of the chipped a year later had a root canal a year after that I had a retreat root canal with Endodontist it’s been about three months two still hurts they wanna do an apico should we wait and let the bone heal
Thomas,
Unfortunately, I don’t have enough information to fully guide you. I would make sure you ask your questions again to your Endodontist. Best of luck!
-Sonia