Teeth saga, not sure what to do

[JuliaBlackberry]

6 months ago I had a vertical trauma to my front two teeth. It didn't hurt too much at the time but as I had had gum disease and treatment around these teeth anyway they were twisted and gappy anyway. With a large chip too, the dentist suggest porcelain veneers over my two front teeth after determining that they were not loose. I went ahead (overseas at the time). Neither tooth would settle down and I felt sharp pains, much worse in the left tooth. A dentist said the tooth was probably over-prepared and did a root canal in the left tooth. It still hurt (with the short sharp pains) several weeks later, and I had a root canal retreatment by an endodontist. It still hurt. After many visits to an endodontist he said it was probably the right tooth confusing my brain and this needed a root canal too, although he mentioned atypical facial pain. I saved this for when I came back to England and had it done with a private endodontist about a month ago. Neither the left or the right tooth feels settled, the left remains worse, but I still feel sharp pains and general grumbling in the area. My left tooth still hurts to tap, my right doesn't. The x-rays look fine. My general dentist said I might have atypical facial pain and the outlook is a bit hopeless which was reassuring..... The endodontist (decades of experience) said he didn't agree with this and felt that I might have a 'crush injury' at the root of the left tooth from the vertical impact, although the tooth does not look cracked. He said if it's not settled in a month or so he would recommend a apicoectomy on the left tooth.
My problem is that I have thrown thousands at these bloody teeth, only to still be in pain. I'm so frightened to have the apicoectomy and the undoubted hundreds of pounds it'll cost only to still be in pain once its all over. I don't know whether to go ahead with this or just struggle on and hope things settle eventually - the endodontist did say that problems like this can take a long time to heal. It's the sharp feelings I'm worried about - without nerves in my actual teeth I don't know what this can be and I'm frightened the apicoectomy won't help me.
I'm tempted to have the both of them out and replaced with implants or a bridge rather than throwing more money at them, but obviously it's better to save your teeth, especially the front ones.
What would you do?

💐 I'm so sorry, what an awful experience you've had! I'm sorry to say that I don't have any real advice as such, but wanted to offer similarly, as someone who has also experienced long term intractable tooth pain.
Mine is more related to my bite, bruxism and TMJ, but I know only too well the trauma of throwing money at dental work, with not real definitive insight into the cause of pain.

Has any sort of referral onwards been suggested, in the neuro/maxfax arena? (If atypical facial pain is being considered as a possible cause?).

Thanks. I'm trying a course of amtitryptiline via the Gp for a month or so, then I'm going to see a max fac. Just feel a bit hopeless but I know that doesn't help, and it is likely to be okay in the end one way or another!

Would it be possible just to wait a few months and see if it settles? I don’t know if you can hang on or if the pain is too great.
You’ve had a trauma and three invasive procedures in six months, surely your poor mouth is still healing.

@Alternista

Would it be possible just to wait a few months and see if it settles? I don’t know if you can hang on or if the pain is too great. You’ve had a trauma and three invasive procedures in six months, surely your poor mouth is still healing.

Hi, I'm really hoping that patience will be a healer and the endodontist did indicate this too. I'm not in agony and I can hang on - just regular discomfort which is tiresome. But I agree that if I can be patient it might calm down. Who knows!

How long after the trauma did the treatment start? I know from personal experience that a bruised ligament can cause acute dental pain, and repeated treatments on the same teeth will likely have exacerbated this. You're not clenching or grinding on them at night are you?

Sorry- I see now. Yes, all of that upheaval in 6 months- has the dentist suggested that it might be inflamed ligaments at all? Does analgesia help?

Does the pain bother you at night or interrupt sleep?

Have you had a CBCT (Mini CT) scan of the area? I've had a patient with a very similar story and it turned out she'd sustained a block alveolar fracture (so broken a block of bone the two front teeth sit in, not the teeth themselves). It took a while but she's maintained the teeth and is comfortable.

@opalescent treatment started a couple of weeks after the trauma. No one has suggested ligament damage. I don't have pain that wakes me over night, if I wake anyway (I often do, I'm not a brilliant sleeper) then I can feel the discomfort.
The endodontist I've been seeing in the UK wasn't convinced by atypical facial pain at all, but it has been suggested by others.

@Darkrainbow

Have you had a CBCT (Mini CT) scan of the area? I've had a patient with a very similar story and it turned out she'd sustained a block alveolar fracture (so broken a block of bone the two front teeth sit in, not the teeth themselves). It took a while but she's maintained the teeth and is comfortable.

@Darkrainbow thank you this is interesting. Did her scans show anything in her bone? Did she have any treatment or just wait it out?

Yes, the endo specalist I use is exceptional. He identified it on CBCT, looking at the standard xrays you can't see it even now I know exactly where to look. I don't know if he did anything special, he just sent her back fixed for me to do the pretty bits on top. If you happen to be in Yorkshire I'm happy to pass his details on.
Atypical facial pain is a bit of a leap (obviously bearing in mind I only have the info you've given and no rads to go off, and you only have my word that I know what im talking about) Are you near any of the dental hospitals? I'd be asking for a refferal to restorative to review, they can then rule out or identify a dental cause and liaise with max fax if needed. Having worked a fair bit of my career in both those departments I'd be thinking restorative first.
The other thing that jumps out at me is your mention of perio and possibly having implants/bridges if the teeth don't resolve. I'd have an honest conversation as to if these options would be suitable for you. If they would it may be a more reasonable option to extract and replace. If due to bone loss they wouldn't and you'd be stuck with a denture it's probably worth trying harder to hold on to them.

@Darkrainbow

Yes, the endo specalist I use is exceptional. He identified it on CBCT, looking at the standard xrays you can't see it even now I know exactly where to look. I don't know if he did anything special, he just sent her back fixed for me to do the pretty bits on top. If you happen to be in Yorkshire I'm happy to pass his details on. Atypical facial pain is a bit of a leap (obviously bearing in mind I only have the info you've given and no rads to go off, and you only have my word that I know what im talking about) Are you near any of the dental hospitals? I'd be asking for a refferal to restorative to review, they can then rule out or identify a dental cause and liaise with max fax if needed. Having worked a fair bit of my career in both those departments I'd be thinking restorative first. The other thing that jumps out at me is your mention of perio and possibly having implants/bridges if the teeth don't resolve. I'd have an honest conversation as to if these options would be suitable for you. If they would it may be a more reasonable option to extract and replace. If due to bone loss they wouldn't and you'd be stuck with a denture it's probably worth trying harder to hold on to them.

Thank you so much. I'm actually south East, nowhere near Yorkshire but not too far from London. Do you think the Eastman would see me? I do have bone loss, although I don't know if this means I wouldn't be eligible for implants or if I could still have with a bone graft. I'm not keen on a denture but not keen on this discomfort either!