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When Root Canals Are Not Enough


Question:

Dear Dr. Crapo: A year ago I had to have a tooth pulled. I’m a big guy and I’ve been told I have a very strong bite. For the most part my teeth are good, with only a few fillings but that tooth had lots done to it including a root canal that wouldn’t settle down, so the tooth was pulled. I was told the root had cracked. Boy the dentist had a tough time getting it out. When he did, he said the bone was hooked so tightly that part of the bone came with the tooth. It made a hole in my sinus so he had to do some fancy work to get the sinus to heal over. It has now and I thought I’d get an implant but I’m told that the bone is too thin, if it exists at all, where the tooth was pulled. It appears that I’ve got several choices. I could do nothing but I’m afraid of shifting. I could do a bridge which I’m told is a good solution to stabilize my bite and give me good chewing power, or I could have a graft in my sinus and when the bone is formed, I get an implant. I’m told it’ll take six to eight months before the implant can be put in and then another three or four before it’s solid enough to put a crown on it. The reason I’m thinking implant is that the teeth they would use for the bridge are like perfect – hardly any fillings, so I’m thinking, why touch them? Is one better than another?


Answer:

Your situation is very interesting because of the strength of your bite. Cracking roots of a molar doesn’t happen every day. When a root cracks and a root canal is performed after the fact, pain may well persist similar to the pain that initiated the treatment. It is almost impossible to know prior to the treatment and is always frustrating for both the dentist and the patient.

Whether you bridge the gap or have an implant placed it will be necessary to ensure the forces of your bite do not go unchecked. After the treatment, your bite needs to be fine-tuned and a good precision orthotic, splint or bite guard be used and monitored to ensure this strong bite does not cause other teeth the same dilemma.

Bridgework done well on strong teeth could last many decades but it certainly is a feature favoring implants to not touch healthy teeth. There will be extra expense to grafting bone in the sinus but that is generally a well-tolerated technique to allow an implant to be placed. Well done, it will give you good service.

The bridge is faster and if you have a dental plan, you’ll get more participation from your insurance. At this point it is preference and a budget decision.


If we can help, we’d like to. Call 778-410-2080 for a consultation.

Based on actual patient cases


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