Fussy... May Be Good
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 as 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 logged 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.
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
778-410-2080