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Old 08-06-2016, 12:17 PM #1
antonina antonina is offline
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Default root canal or extraction?

is it possible/wise to extract a tooth which is part of a bridge?

i have a bridge that is failing. it is the last remaining 1/3 of an original bridge which was an upper "roundhouse" constructed in three parts, soldered together. the other 2/3s of the bridge are gone.

last week a piece of the porcelain attached to the left front incisor disintegrated, leaving an opening 1/32" wide by 1/16" long. it is quite painful now, but had caused no pain at all prior to the disintegration.

i saw a prosthodontist who suggested re-doing the bridge but recommended first that i see an endodontist for a root canal on the fractured tooth before he could create a new bridge.

because of all the unfavorable reviews i've read of root canal therapy, i am very leery of it & would prefer to have the incisor extracted.

i would like to suggest the idea of extracting the tooth but want some idea of its feasibility before i see him again.

i would appreciate any thoughts & suggestions!
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Old 08-06-2016, 02:17 PM #2
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Hi antonina,

It sounds like this bridge is quite old. What do you have replacing the other 2/3rds of the bridge?

The fractured tooth is most likely heavily decayed and moderate to severely fractured. The purpose of doing the root canal is to attempt to "buy" time while retaining an unhealthy tooth for an uncertain amount of time. However, the financial aspect as well as the cost to your health of retaining an unhealthy tooth needs to be weighed against the attempt to retain it. All root canaled teeth are a chronic source of infection and inflammation because they will always harbor dead nerve tissue inside of the hundreds of inaccessible microscopic canals and because they no longer have a blood supply as the vessel is severed during the root canal procedure.

It is never ideal to anchor a bridge of any kind onto root canaled teeth because they are vulnerable to fracture and abscessing due to the chronic infection in those tiny canals and no blood supply. The bacteria from those canals easily spreads beyond the tooth into the adjacent teeth, the jaw bone and beyond. So they are not ideal anchor teeth.

The porcelain fracturing off of the bridge is not what is causing the pain. The tooth is infected most likely due to extensive decay and it may be fractured into the pulp chamber and that's what is causing the pain. Root canaling this tooth will not cure the infection or make the tooth well again.

If your other upper teeth are currently being replaced with a removable partial denture then the teeth associated with this bridge may also be added to your existing partial or you may need to have a full denture made.

The bottom line is what do you think is in your best interest when you put all the facts together. Financial cost, health risks, and no long term stability.

I am attaching a tooth diagram to show you just how many microscopic canals are in every tooth, including the root system. Even if your tooth is broken off at the gum line, the entire root system will still be present in the jaw bone. The canals are labeled dentin tubules and shown in light brown color.

I hope this was helpful to you. Please let us know if you have other questions.
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root canal or extraction?-dentin-tubules-jpg  
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 08-06-2016, 03:16 PM #3
antonina antonina is offline
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hi bryanna,

thank you for your response! i have no teeth where the 2/3s of the old bridge is gone. the bridge is more than 20 years old! i chew only on the left side...the side of the remaining failing bridge.

the fracture is on the porcelain face of the incisor which is baked onto the metal frame. the tooth itself consists of a heavily drilled down, pointy stump.

i am very worried about the pain connected with a total renovation of my mouth. in order to be fitted with dentures, i guess i will need to have all remaining teeth extracted. yikes!

several dentists have said i need about 8 or 9 implants. but dentures may be a quicker solution than implants.

the other problem is the costs involved with implants. dentures, i think, would be less expensive but i don't know if dentures are more aesthetically pleasing than implants with crowns. also, i have heard that dentures take alot of getting used to. what do you think?

so if i don't have the root canal, what if anything, can stop the pain? how does the bad tooth get extracted? does the entire bridge need to get removed asap?

i am very confused & overwhelmed!
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Old 08-07-2016, 01:39 PM #4
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Antonina,

I am going to re post some of your post and answer you in bold type. This can make following a bit easier.

<<i have no teeth where the 2/3s of the old bridge is gone. the bridge is more than 20 years old! i chew only on the left side...the side of the remaining failing bridge.>>

A 20 YR OLD BRIDGE HAS LONG LOST IT'S FUNCTIONAL VALUE CONSIDERING THAT THE CEMENT THAT HOLDS THE BRIDGE ON ONLY HAS A 5-10 (MAX) LIFE SPAN. JUST LIKE ANY OTHER DENTAL ADHESIVE, THE BOND WEARS OUT OVER TIME. AS THE BOND LOOSES IT'S ADHESIVENESS, THE BRIDGE BECOMES LESS SNUG ON THE ANCHOR TEETH WHICH MAY OR MAY NOT BE NOTICEABLE AT THE EARLY STAGE. ANY UNEVEN MOVEMENT IN THE BRIDGE CAUSES THE BITE TO CHANGE RESULTING IN DAMAGE TO THE ANCHOR TEETH AS WELL AS EXCESSIVE WEAR TO THE OPPOSING TEETH.

A ROUND HOUSE BRIDGE IS DESIGNED TO RELY ON ALL OF THE ANCHOR TEETH TO HOLD THE BRIDGE IN PLACE AND KEEP THE BITE IN PROPER ALIGNMENT. ANYTIME YOU HAVE ANCHOR TEETH REMOVED FROM A BRIDGE, THE INTEGRITY OF THE BRIDGE BECOMES C0MPROMISED AND SO DO THE TEETH STILL PRESENT HOLDING THE LAST BIT OF THE BRIDGE IN.

WHAT ARE YOU WEARING ON THE RIGHT UPPER SIDE OF YOUR MOUTH?

<<the fracture is on the porcelain face of the incisor which is baked onto the metal frame. the tooth itself consists of a heavily drilled down, pointy stump>>

THE PORCELAIN ON THE EXISTING PIECE OF BRIDGE HAS WORN OUT AND DUE TO YOUR UNEVEN BITE, IT HAS BROKEN OFF. THE TOOTH ITSELF IS AS YOU SAID HEAVILY DRILLED DOWN AND IN ALL PROBABILITY INFECTED AND FRACTURED. THERE IS MOST LIKELY LITTLE ROOT STRUCTURE LEFT WHICH IS NOT GOING TO BE ADEQUATE FOR HOLDING ON TO ANYTHING IRRELEVANT OF WHETHER IT IS ROOT CANALED OR NOT. KEEP IN MIND THIS TOOTH HAS BEEN WAY OVER USED FOR CHEWING FOR A LONG TIME. IT WAS JUST A MATTER OF TIME BEFORE IT SHOWED SIGNS OF A PROBLEM.

<<i am very worried about the pain connected with a total renovation of my mouth. in order to be fitted with dentures, i guess i will need to have all remaining teeth extracted. yikes!>>

WHAT TEETH IN THE UPPER ARCH ARE REMAINING? DO YOU HAVE PERIODONTAL DISEASE, RECEDED GUMS, POOR ORAL HYGIENE? HOW LONG AGO WERE THE UPPER RIGHT TEETH REMOVED? DO YOU HAVE YOUR LOWER TEETH, ARE THEY BRIDGED ALSO?

THE JAW BONE OF EXTRACTED TEETH DIMINISHES BY 30-50% WITHIN THE FIRST YEAR OR TWO DEPENDING ON THE INDIVIDUAL. IN SOME PEOPLE IT'S A BIT LONGER TO GET TO THAT DEGREE OF LOSS. IF A BONE GRAFT WAS SUCCESSFULLY PLACED AT EACH EXTRACTION SITE AT THE TIME OR SOON AFTER THE EXTRACTION, THEN THE OVERALL LOSS OF JAW BONE WOULD BE LESS DELAYED OR AT LEAST LESS FOR A LONGER PERIOD OF TIME. IF THE PERSON HAD OR HAS PERIODONTAL DISEASE OR IF THE EXTRACTED TEETH WERE BADLY INFECTED OR ROOT CANALED, THEN THE BONE LOSS AFTER EXTRACTIONS IS LIKELY TO BE MORE SEVERE IRRELEVANT OF THE PLACEMENT OF BONE GRAFTING.

<<several dentists have said i need about 8 or 9 implants. but dentures may be a quicker solution than implants.>>

DENTAL IMPLANTS CAN BE GREAT ANCHORS FOR IMPLANT BRIDGES OR DENTURES. HOWEVER, THE SUCCESS OF EITHER OF THEM ALL DEPENDS ON THE HEALTH OF YOUR JAW BONE, THE AMOUNT OF JAW BONE, YOUR ORAL HYGIENE,YOUR DIET AND LIFESTYLE HABITS, MEDICATIONS YOU TAKE AND YOUR OVERALL PHYSICAL HEALTH.

<<the other problem is the costs involved with implants. dentures, i think, would be less expensive but i don't know if dentures are more aesthetically pleasing than implants with crowns. also, i have heard that dentures take alot of getting used to. what do you this>>

DENTAL IMPLANTS ARE VERY COSTLY AND SO IS THE BRIDGEWORK OR DENTURES THAT GO OVER THE IMPLANTS. IT IS A HUGE UNDERTAKING AND THEREFORE IMPERATIVE THAT YOU ARE A GOOD CANDIDATE TO GO THROUGH ALL OF THAT DENTISTRY.

REMOVABLE DENTURES ARE LESS COSTLY BUT IT CAN BE DIFFICULT TO GET A GREAT FIT IN SOMEONE WHO HAS HAD PREVIOUS EXTRACTIONS. THE REASON BEING IS THAT AS THE BONE LOSS OCCURS AT THE SITES OF THE PREVIOUSLY EXTRACTED TEETH, THE BONY RIDGE CHANGES SHAPE MAKING THE RIDGE FROM ONE SIDE OF THE ARCH TO THE OTHER SIDE UNEVEN. SO YOU MAY HAVE TO HAVE SOME ORAL SURGERY TO LEVEL OUT THE RIDGES TO MAKE A MORE EVEN PLANE OF BONE FOR THE REMOVABLE DENTURE TO SIT UPON. THIS IS NOT AN UNUSUAL PROCEDURE FOR ORAL SURGEONS TO PERFORM. DENTURE WEARERS WILL TELL YOU THERE IS AN ADJUSTMENT PERIOD TO GET USE TO THE DENTURES. BUT NO TWO DENTURE WEARERS ARE GOING TO EXPERIENCE THE EXACT SAME PROBLEMS OR SUCCESS. IT IS ALL DEPENDENT UPON THE INDIVIDUAL CASE AND HOW ACCURATE THE PROSTHODONTIST TAKES THEIR MEASUREMENTS, MOLDS, ETC TO SEND TO THE LAB FOR THE FABRICATION OF THE DENTURES.

<<so if i don't have the root canal, what if anything, can stop the pain? how does the bad tooth get extracted? does the entire bridge need to get removed asap?>>

THE TOOTH IS MOST LIKELY INFECTED AND THE ONLY ATTEMPT AT CURING THE INFECTION IS TO REMOVE THE SOURCE, WHICH IS THE TOOTH. NOTHING ELSE WILL "CURE" THE PROBLEM OR THE PAIN. HOW MANY OTHER TEETH ARE HOLDING THIS PORTION OF BRIDGE? I THOUGHT THIS WAS THE ONLY ONE? IF THERE ARE OTHER TEETH HOLDING THIS BRIDGE ON, IT REALLY WOULDN'T BEHOOVE YOU TO HAVE THE SURGEON CUT OUT THIS ROOT SYSTEM AND LEAVE THE BRIDGE IN AS THIS BRIDGE HAS OUT LIVED IT'S FUNCTIONALITY.

<<i am very confused & overwhelmed!>>

I KNOW YOU ARE. IT IS A LOT TO TAKE IN BUT THERE ARE THINGS YOU NEED TO CONSIDER BEFORE MOVING FORWARD. I HAVE PROVIDED SOME OF THOSE THINGS FOR YOU THAT YOU CAN DISCUSS WITH YOUR ORAL SURGEON AND WITH THE PROSTHODONTIST.
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***

Last edited by Bryanna; 08-07-2016 at 01:57 PM.
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Old 08-08-2016, 03:02 PM #5
antonina antonina is offline
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Default just back from dentist

hi bryanna,

i went to my gen. dentist this morning. he xrayed the tooth & found the source of the pain...it has the beginning of an abcess & when he pressed the gum just above it, it killed! i have started taking amoxicillin & will stay on it until the infection abates.

he said i could go a couple of ways: extract the remaining teeth, leaving me no upper teeth at al, then creating a denture & voila!

second option is to extract the 2 central incisors and replace them along with the missing right quadrant with a "partial" but keeping the failing remainder left side bridge but he cannot predict if the bridge will last or just keep failing.

so the dilemma involves choosing one of these two scenarios. a third possibility is to get implants and use them to anchor fake teeth. to my mind this will be very costly and much more time consuming than a denture or a partial.

thanks again for your in depth analysis and sharing your expertise with me.
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Old 08-08-2016, 10:36 PM #6
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Antonina,

Abscesses are the result of a long term infection. The antibiotic may temporarily subside your symptoms but it will not cure the abscess. The abscess is the result of the infection spreading beyond the tooth and into the jaw bone. Pressing on the gum released the fistula of pus that had formed. The fistula will fill up again. The only way to attempt to cure the infection is to remove the tooth.

Based on your description, it sounds like your teeth are in guarded condition and we already know the old bridge has out lived it's functionality. That being the case, it is inevitable that your teeth will need to be extracted and you will be fitted for a full denture most likely sooner than later. So you have to decide if you want to spend the time and money on temporary patch ups and a partial denture ... or remove the teeth and do the full denture.

It is not an easy decision and of course you need to feel ready and comfortable with whatever you decide to do.

I wish you the best ... we're here if you have other questions.

Bryanna





Quote:
Originally Posted by antonina View Post
hi bryanna,

i went to my gen. dentist this morning. he xrayed the tooth & found the source of the pain...it has the beginning of an abcess & when he pressed the gum just above it, it killed! i have started taking amoxicillin & will stay on it until the infection abates.

he said i could go a couple of ways: extract the remaining teeth, leaving me no upper teeth at al, then creating a denture & voila!

second option is to extract the 2 central incisors and replace them along with the missing right quadrant with a "partial" but keeping the failing remainder left side bridge but he cannot predict if the bridge will last or just keep failing.

so the dilemma involves choosing one of these two scenarios. a third possibility is to get implants and use them to anchor fake teeth. to my mind this will be very costly and much more time consuming than a denture or a partial.

thanks again for your in depth analysis and sharing your expertise with me.
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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