@Benchwmer 43355 wrote:

After two years, the tooth is still in the mouth. It has never healed completely (maybe due to the tramatic occlusion) It has been re-evaluated at 3 month recalls, a sinus tract has sometimes reappeared, however much smaller and localized than the start. I have repeated the laser therapy and used antibiotic therapy, it clears up. I’ll see where we are at next month.
Jeff

In my opinion and experience, failure to completely heal indicates a failure to completely remove the source of the infection that the patient’s immunes system has to deal with. Untreated lateral/accessory canals, failure to maintain a watertight seal of the endodontica access are all common reasons for failure of root canal therapy.

This treatment seems to be an acceptable alternative to NSER or apical surgery as long as the patient understands that duration of quiescent perieods may be indeterminate. I’d also suggest regular radiographs to monitor the condition of the tooth as well; after all, this approach leaves a potential source of circulating infalmmatory mediators such as C-reactive proteins in thier bodies. Patients with challenged immune systems may have more difficulty keeping these infections contained over time

Don’t get me wrong, I think this is a very nice alternative treatment, but it does not remove the source of the infection, only temporarily lowers the infectious load. Even apical surgery may not remove the infected area of the canal (which has to be assumed to be the entire canal complex), but it does allow closer access and visualization of the root in order that a laser may be used as an enhanced dinsinfection agent.

Arguments can be made as to whether there is truly any treatment to heal a failing endo considering the statistics of NSER, apical surgery/retrofil, or closed laser irradiation of the fistulous tract. Broadly speaking, the more invasive/time consuming procedures offer statistically longer periods of apparent health, while closed laser irradiation is relatively quick, painless, and does show positive results of varying duration. And as such, offering to the patient as an option, I see no reason why you would not charge for the procedure as long as the patient has a realistic understanding of the options. You’re still doing the endodontist a favor; believe me, they don’t want to have to retreat their own cases if there is a viable alternative.

Just my $.02 on a Sunday morning

5 years is nice service for the patient. 🙂

I’ll be calling my patient with yours and Ron’s protocols.

Thanks
Walt