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…
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.
Let me know any questions you have in the comments below.