Q: Dr. Crapo: I’ve got a bit of a dilemma and I don’t know
if I’m being too fussy, (aka) anal, or if my doctors (dentists) are not
explaining things. Several years ago, I had a root canal on my last upper left molar. The tooth was then crowned and everything has been okay. Six months ago, I felt a little tenderness on the gum beside the tooth, but it only lasted a
day or two. I had an appointment with my dentist for a cleaning, so I thought
I’ll just have him check it out then. At the appointment, he took an x-ray.
When he saw it he was very surprised and said, after looking in my mouth, that
the tooth was lost. I’m very dogged about why things have to be done, so I
asked him a bunch of questions to which he just kept saying, there’s a lot of
disease around the roots of the tooth and the tooth was probably cracked, so it
couldn’t be saved. I asked if he could send me for a second opinion which he
did, because he doesn’t extract teeth. When I saw the surgeon, he said it
needed to come out because the root canal had failed and that was the best
thing to do. Here’s my dilemma. I don’t understand what’s happened, other than
they said the root is cracked. Is that all that can be done? What happens to the
tooth (its biting opposite) on the bottom? I don’t want to lose the tooth, but
mostly I want understanding and options.
A: When a bridge comes loose there is always a
reason. Sometimes it is operator (the dentist) fault; other times it’s an
anatomic problem that is not discovered before the procedure (i.e. a bad bite).
Most of the time it is the latter, but careful analysis before the bridge is
made, prevents your kind of problem most of the time.
When you’re told that too much bone was removed from the side, it means that one of
the four sides of the socket was broken away as the tooth was removed. Most of
the time, it is the cheek side portion. This inevitably makes the ridge of bone
narrower than is ideal or too narrow for implant placement. On upper teeth, the
ridge may have also shrunk to the point that it is too close to the sinus. Your
problem is a narrow ridge and not enough room between the ridge and the sinus.
A bone graft of the ridge and the sinus will give you enough bone to place the
implant. This grafting can be done together so that six to eight months later
an implant can be placed.
The root canal should be reassessed. Decay means leakage and leakage may compromise
your root canal. Have that done and then place the crown while the bone graft
is maturing. Lastly, be sure that your bite is not going to place excessive
force on the new dentistry.