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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What Are My Odds?

Q: Two days ago I went to see my dentist for a checkup and cleaning. I’ve needed an implant but have been putting it off. The hygienist noted that we’d talked about it and brought up the subject again. I said I was still thinking about it, not wanting to get into my real reason. When my dentist came in he checked my teeth and said things looked fine; then asked about my missing tooth. In an instant, I decided to come clean so I said “I don’t know what to do, my brother had one, it got infected right off the bat and had to be removed”. My dentist said he hadn’t seen that happen before but the specialist he refers his patients to would be able to answer my questions. I don’t want to go somewhere else to be talked into something that scares me. How often does my brother’s problem happen and will it happen to me? I don’t want a bridge but I know the space is affecting my smile – it’s the second tooth behind my upper right eye tooth. Do you have any experience with this? Please advise?

A: Many years ago, when I was taking my implant training, I watched a surgery for a young girl who had lost her upper lateral incisors (the teeth beside her upper front teeth). The surgery that was performed for both implants was identical. The next month when we gathered to observe and perform implant surgeries, I was interested to see this young girl scheduled for implant removal. After she was prepared for surgery we asked why one of the implants was failing. At first, the director of the course, who had placed the implants, said there wasn’t an apparent reason but turned the question back on the group (sort of like “House”) asking what we thought. Several ideas were presented – too much trauma caused at placement, the patient not following post-op instructions, and one I hadn’t heard before – drilling into a latent abscess. When a tooth is extracted the socket must be carefully examined and explored to insure no infected tissue is left behind (the abscess). Many times, the socket is not thoroughly cleaned out and the body heals over it. When an implant is placed years later, and part of the “quiet” abscess is encountered unbeknown to the surgeon or patient, it can flare up and cause failure of the implant. When this happens, the implant must be removed, the area completely and thoroughly cleaned out and bone grafted before a new implant is placed. I know this might not be reassuring but the surgeon will make good on the cost and care of these problems. This is a rare occurrence, so don’t be put off. The chances are less than 1% that you’ll have problems.

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

Based on actual patient cases

© Calvin Ross Crapo

Victoria Implant Centre 778-410-2080

www.VictoriaImplantCentre.com