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Medical Forum / General / Dentistry / April 2009

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Failed Root Canal?

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Bob Adkins - 10 Apr 2009 16:57 GMT
Hi,

I had a 4 tooth bridge attached to No 32 about 10 months ago. My
dentist did a root canal on it, and it stayed sore while I wore my
temporary bridge.

Because of the soreness, he re-worked the root canal through the
temporary. No luck! Still sore with mild biting pressure.

After a month with the re-done root canal, he said that occasionally,
the soreness goes away when the permanent bridge is cemented on. So I
let him talk me into permanently cementing in the bridge.

No luck! It's still sore, in exactly the same way.

My bite is fine, the tooth is so low it's hard to even bite on it. I
have to bite on a nylon bead (or food) to feel the soreness. I do not
grind my teeth, and No. 1 and No. 32 wouldn't contact even if I did.

If it's a cracked root, is that always a death sentence? Please say
no!

I really need that tooth to support a very large,  expensive bridge.
I've already had to sell my tractor and some land to pay for that
bridge.  From what I've heard, I can't afford an implant. And I really
need the bridge, or I can't chew at all on the right side.

Thanks for any advice! I really appreciate what you guys do!

-

Bob
ihabkmaleg@gmail.com - 10 Apr 2009 18:13 GMT
> Hi,
>
[quoted text clipped - 28 lines]
>
> Bob
tenthmed - 10 Apr 2009 21:28 GMT
> Hi,
>
[quoted text clipped - 28 lines]
>
> Bob

Endo on #32 (wisdom tooth)? WTF!  Weren't you told about implants
( and bone grafting)  for #30 and #31 areas. Is only #31 missing? All
that to replace a 2nd molar? How many dentists would utilize a wisdom
tooth, with endo mind you, as an abutment for a bridge? Not a good
situation if this is indeed true. I hope that I have it all wrong.
Someone straighten me out.
Steven Fawks - 11 Apr 2009 02:24 GMT
> Endo on #32 (wisdom tooth)? WTF!  Weren't you told about implants
> ( and bone grafting)  for #30 and #31 areas. Is only #31 missing? All
> that to replace a 2nd molar? How many dentists would utilize a wisdom
> tooth, with endo mind you, as an abutment for a bridge? Not a good
> situation if this is indeed true. I hope that I have it all wrong.
> Someone straighten me out.

While I believe your opinion is the 'right' one, in these days of
'insurance', the patient might have an 80% benefit for the endo,
and 50% coverage on the bridge.  The payment for the 'correct'
treatment (implants) might be ZERO.

Economics can often lead to decisions based on less than sound
treatment options.

JMO,
Steve
Amatus Cremona - 11 Apr 2009 04:36 GMT
Maybe the teeth had drifted forward and the third molar had large well
separated roots.??

On Apr 10, 11:57 am, Bob Adkins <m...@pit.com> wrote:
> Hi,
>
[quoted text clipped - 28 lines]
>
> Bob

Endo on #32 (wisdom tooth)? WTF!  Weren't you told about implants
( and bone grafting)  for #30 and #31 areas. Is only #31 missing? All
that to replace a 2nd molar? How many dentists would utilize a wisdom
tooth, with endo mind you, as an abutment for a bridge? Not a good
situation if this is indeed true. I hope that I have it all wrong.
Someone straighten me out.
Bob Adkins - 11 Apr 2009 16:47 GMT
>Endo on #32 (wisdom tooth)? WTF!  Weren't you told about implants
>( and bone grafting)  for #30 and #31 areas. Is only #31 missing? All
>that to replace a 2nd molar? How many dentists would utilize a wisdom
>tooth, with endo mind you, as an abutment for a bridge? Not a good
>situation if this is indeed true. I hope that I have it all wrong.
>Someone straighten me out.

Thanks for the reply!

I specifically asked my dentist if the wisdom tooth was sufficient to
support such a large bridge. He said he used a loose formula, which
showed there was plenty of root to support it. No. 32 did indeed
appear to be pretty robust for a wisdom tooth.

No. 32 was tilted forward due to 31 and 30 being missing for years,
and the crown was cracked. The crack had to be removed and the tooth
crowned,  so my dentist sort of talked me into doing the bridge while
we were crowning the tooth anyway. He did mention an implant. The
price made me almost swallow the irrigation tube, so we didn't discuss
it at length. Regardless of expense, I would have preferred a
sure-thing implant to iffy wisdom tooth anchorage. Even implants have
a significant failure rate, as I understand it.

On the first root canal attempt, X-Ray showed a little filler material
extruding from 1 of the root tips. The reworked root canal X-Ray
showed a significant blob of filler material extruding from 1 root.

My dental insurance is almost worthless. It does pay 80%, but only up
to $1K maximum per year. I doubt it could  have been a factor in the
decision making process.

Many thanks,,,
Amatus Cremona - 11 Apr 2009 16:55 GMT
$1K of dental coverage per year is about average.  Remember that this is NOT
insurance, but a pre-paid tax free benefit.

A small "puff" of sealer out the root tip is normal.

Most 3-unit bridges end up costing about $3K and the implant $4K.  If you
consider the added cost of any RCT and cores, the difference gets even
smaller.  Then, there is the consideration of grinding away good enamel.

Signature

/

Amatus

/

>
>>Endo on #32 (wisdom tooth)? WTF!  Weren't you told about implants
[quoted text clipped - 29 lines]
>
> Many thanks,,,
tenthmed - 11 Apr 2009 18:36 GMT
> On Fri, 10 Apr 2009 13:28:45 -0700 (PDT), tenthmed
>
[quoted text clipped - 31 lines]
>
> Many thanks,,,
Re: your posting in SMD

1. your dental "benefits" plan - US$1k/yr - is the norm. Also, use-it-
or-lose-it, i.e. - no roll-over of unused benefit.
2. IIRC, a study showed that root-canal treatment and single tooth
implant had similar success rates at 1yr.         However, they didn't
look at 5yr, 10yr, etc.
3. It is my experience, and only that - MY anectotal experience - ,
that 3rd molars, and most especially "tilted" 3rd molars, are not
suitable as bridge abutments. They are useful, until they fail, as
distal rest seats - that is the last most tooth with a stop - for
removable partial dentures, but almost never for fixed bridgework.

Someone else on SMD will disagree, but most experienced clinicians
will generally agree.
 
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