Hi JR,

Nice description of your dental case. May I ask, what is your background that provides you with that much knowledge..??

Based on your description, it appears that the oral surgery and dental implant that you had done regarding tooth #19 was text book and nothing unusual stands out to me about that. It is also not unusual for someone who has had a dental history of root canal therapy in one or more adjacent teeth (extracted or still present) to eventually be <possibly> misdiagnosed with PN or other neurological disorder and prescribed medications to help subside the symptoms. Therefore, I think it's wise to take into consideration the health status of not just the aftermath of the extracted tooth #19 but with the adjacent #18 root canaled tooth and #20 tooth with the widened PDL.

The root canal procedure and the apicoectomy procedure irrelevant of how many times they are done or how well they are done cannot cure the infection inside of the tooth as there is no access to the many hundreds of infected microscopic canals inside the tooth called dentinal tubules. The harboring of bacteria in these canals will indefinitely produce metabolic toxins. I will attach a diagram for you to visually see why those infected canals are one of the main reasons root canaled teeth remain infected.

Another reason the tooth remains so sick is because after the root canal or apicoectomy there is no longer any blood flow into the tooth and into the tiny canals preventing the influx and buildup of bacteria.

The pathology that is present in root canaled teeth and then later on in the surrounding tissue and bone is not always clinically visible. It is often not picked up on 2 dimensional radio graphs or 2D scans either. What is more useful is a 3D cone beam computed tomography xray image.

I am going to recommend that you read the book entitled "The Toxic Tooth... How a root canal could be making you sick, written by Dr Kulacz and Dr Levy. This book will offer you a plethora of information that will bring light to what (unrealistically) appears to be a rare dental problem associated with root canaled teeth. Just a blip from the book in Chapter Five it reads... <Root canal treated teeth are hotbeds of pathogens and toxins. DNA evidence shows these dental pathogens commonly travel to and embed in various bodily tissues.>>

The book can offer you so much more than I can here. I hope you will consider reading it before you mask your symptoms with medication and before having any further dental work done.

Bryanna