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Medical Forum / General / Dentistry / December 2007Getting #31 Root Canaled Next To Impacted Wisdom
I have to have #31 crowned and possibly root canaled because it hurts when I bite hard food. There is a small crack but it doesn't extend to the gumline. My question though is this: will the crown interfere (bump into) the horizontally impacted wisdom tooth? There is a small space between the 2 teeth on the x-ray. Question two: If it gets a root canal and ever developed an abscess, can that spread to the wisdom tooth when it's in that position? What would the dentist then do? Would they be able to treat it with antibiotics or would they have to get the wisdom tooth extracted? > I have to have #31 crowned and possibly root canaled because it hurts > when I bite hard food. There is a small crack but it doesn't extend to [quoted text clipped - 6 lines] > the dentist then do? Would they be able to treat it with antibiotics or > would they have to get the wisdom tooth extracted? The crown should be made to fit the contours of the tooth without impinging or interfering with adjacent teeth. They are custom made to create ideal contours that end up being flush with the remaining tooth surfaces so it's just like having a brand new top portion to the tooth. You might want to consider having the horizontally impacted wisdom tooth before the crown since sometimes during difficult extractions, inadvertant damage or dislodgement to adjacent crowns can occur. I don't see any point in keeping a horizontally impacted wisdom tooth unless it's removal would pose risks to the jaw or nerves. If the root canaled tooth abscesses, the infection generally stays associated with the involved tooth, but it can spread to the soft tissues around the area. In most cases, it shouldn't adversely affect a wisdom tooth, but if left long enough, the infection could potentially create all sorts of problems. Zzzdentist www.dentalminds.com >I have to have #31 crowned and possibly root canaled because it hurts >when I bite hard food. There is a small crack but it doesn't extend to >the gumline. My question though is this: will the crown interfere (bump >into) the horizontally impacted wisdom tooth? There is a small space >between the 2 teeth on the x-ray. The problem with any 'crack' or 'fracture' of any tooth is that the extent cannot be determined just by looking from the outside. Radiographs rarely reveal fractures unless they are non-restorable. Depending on age, position, difficulty in restoration, etc... generally my approach is to treat the RCT and place a good fuji9 build-up, surgically remove the impacted wisdom tooth, then prepare/place the crown on the RCT'd molar after WT surgery healing is acceptable. >Question two: If it gets a root canal and ever developed an abscess, can >that spread to the wisdom tooth when it's in that position? What would >the dentist then do? Would they be able to treat it with antibiotics or >would they have to get the wisdom tooth extracted? Hey dude ! That's more than just a one question #2 !!! OK, on a second molar RCT with an impacted WT <of any angle> it is extremely unlikely for a periapical abcess to spread from one tooth to another. This is also true of any other teeth, say from a 1st bicuspid to the 2nd bicuspid. There are situations that this can occur and it is called anachoresis. There is almost always a periodontal component in those type of cases. IOW kinda rare. Wherein lies the rub is the impacted lower WT that has periodontal problems up against a 2nd molar that has distal decay into the pulp. Getting a good clean margin for a crown on the distally decayed 2nd molar that has RCT is very often dependant on removing the impacted 3rd molar <WT>. If the "horizontally impacted" WT is *not* removed it is unlikely that a long term stable solution can be achieved. If you can post or send some radiographs will be able to advise you further. >> I have to have #31 crowned and possibly root canaled because it hurts >> when I bite hard food. There is a small crack but it doesn't extend to [quoted text clipped - 35 lines] > If you can post or send some radiographs will be able to advise you > further. Agree entirely. And we've all seen that final scenario played out again and again. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks so much for that information. I stood in the kitchen with a camcorder and got a pretty feeble picture of the x-ray. You will see that the two teeth in front of 31 are extracted. The dentist said it's too wide a gap for a bridge so for now, it's empty. Anyway, here is the x-ray: http://pic20.picturetrail.com/VOL83/532620/15499366/294301906.jpg The dentists and oral surgeons I've seen over the years have been hesitant to extract the wisdom tooth and said that if at my age (59) t hasn't caused a problem, it may never. But now with this new development, I am concerned. Isn't it possible to leave it and just crown or root canal 31 without the scenario you describe? I have heard horror stories about the pain and temporary, possibly permanent paralysis after a horizontally impacted wisdon, especially at my age so I am pretty freaked about that. My dentist also said that it may not need a root canal, he would only know once he starts drilling for the crown, which it does need. Sorry about the x-ray not being so clear but I think you can see the amount of space between 31 and 32. BTW, newbie, you can call me dude anytime but I am a woman :-) > Thanks so much for that information. I stood in the kitchen with a > camcorder and got a pretty feeble picture of the x-ray. You will see [quoted text clipped - 20 lines] > > ------------------------------------------------------------------------ Doing the crown should not be a problem. What I cannot tell from the x-ray is if there is any bone between 31 and 32. If there is no periodontal pocketing, I see no reason not to prepare the tooth for a crown and put a temporary crown on and see how the tooth reacts. If the surgeons say it's risky to take out the #32, I'm not going to sit here and call them sissies. There is always a measure of risk in these things, and the guy or gal holding the knife has a right to say no. Steve >> Thanks so much for that information. I stood in the kitchen with a >> camcorder and got a pretty feeble picture of the x-ray. You will see [quoted text clipped - 30 lines] > >Steve Agreed. I wouldn't be too gung-ho to remove that tooth (32) either. |
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