Hi azaleagal,

I am in the dental field and can offer you some information here.

The most important thing for you to know is that ALL root canaled teeth are chronically inflamed and infected simply because it is not possible to remove all of the infected nerve tissue from inside of the tooth. Therefore this tooth has been unhealthy for over 25 years. Re treating the tooth with another root canal procedure will not make this tooth healthy again.... as the same infected nerve material will still be present inside of the microscopic canals after the second procedure.

The infection inside of the tooth eventually proliferates and moves into the jaw bone. At which time some people will get pain and/or swelling.... others will develop a fistula. For the fistula to form, the bacteria had to burrow a hole through the bone leaving a path or void of deterioration in the bone resulting in permanent bone loss.

Your endo is correct.... the fistula may close and reappear several times. He also should have told you that with each occurrence you will lose more bone and the infection will have spread even deeper.

When a dentist uses the term "save a tooth" when referring to endodontic treatment it does not mean "cure" the problem. It simply means "retain" the tooth (and the problem) until the inevitable removal of the tooth.

It is very important for you to know that this infection is not just limited to this tooth. In addition to the fact that the bacteria has spread to the jaw bone, your immune system has been fighting this infection for 25 years. From a health standpoint the wiset option is to rid yourself of source of the infection which is the tooth.

Regarding the replacement of this tooth...
Anytime a root canaled tooth is extracted, especially one with a long term history of being root canaled, there is always a chance that the bone will not heal to a completely healthy state. This means the bone would remain in a compromised state and/or there may be significant permanent bone loss.
Replacing a root canaled tooth with a dental implant is risky due to those factors. Adding bone graft material to unhealthy bone carries a very high risk of failure.

Tooth #30 is a tooth that is used to chew with and if it is not replaced with something then the adjacent teeth will eventually drift towards the open space. You should discuss your replacement options with your restorative dentist. Other than an implant, you may be a candidate for a 3 unit permanent bridge.... a small removable one tooth appliance called a Nesbit.... or a removable partial denture.

I hope this information is helpful. Please let us know how you're doing!
Bryanna