Hi burninghead,
Firstly, irrelevant of how well a root canal treatment is performed, the tooth will be infected because there is no access to the microscopic canals called dentin tubules. I will post a diagram of the anatomy of a tooth so you can see the many many hundreds of tiny canals every tooth has and how impossible it is to treat the tooth in it's entirety. Using a microscope during a root canal procedure sometimes allows the dentist to detect remnants of nerve tissue inside the large canals and/or sometimes (but not always) a fracture can be picked up. However, using a microscope does not alter the procedure to be flawless because there is no access to the infected nerve tissue inside the dentin tubules.
Secondly, a root canal procedure should never be done because the source of the pain is undetermined. Diagnostic tests and non invasive treatment should be done first to determine the possible cause of the pain and treat accordingly. That would include:
* Ask the patient and look for clinical signs of clenching or grinding of the teeth.
* Check the bite for malocclusion.
* Do a thorough periodontal check up, taking pocket measurements, check for gum recession and mobility.
* Take diagnostic xrays to check the health of the pulp chamber and periodontal ligament. If the pulp is inflamed and/or the ligament is wide or inflamed it could indicate that there is excessive pressure on a tooth (due to bruxism or malocclusion) or when an infection is brewing.
*Discuss diet and lifestyle with the patient... do they eat super hard foods or chew on ice or chew on the end of a pen or other object out of habit ....all of which could cause fractures in the tooth or in the filling of a tooth.
All of those things, with exception to an infection, can usually be remedied without injury to the tooth or to the nerves of the tooth.
The medication that was likely used inside the tooth to "kill the pain" could be Sodium hypochlorite (bleach) and/or hydrogen peroxide. Both of which carry high risks for complications if not injected into the tooth properly. Again, neither of these medicaments go inside the dentin tubules.
Regarding the immediate placement of a dental implant after the extraction of a root canaled tooth.... it would depend on the health of the bony socket, the actual bone and the surrounding tissue.
It is imperative that all teeth be surgically extracted which includes the removal of the entire tooth, a thorough surgical debridement of the socket in it's entirety and removal of all diseased tissue and bone.
A risk of dental implant failure that is not often mentioned to the patient is that when the implant is placed next to or in between root canaled teeth, the infection from the root canaled tooth/teeth can easily travel to the bone where the dental implant was placed which could lead to all sorts of dental as well as systemic problems. For that reason, it is not wise to place a dental implant next to or in between root canaled teeth.
If you were to remove both of those teeth, your replacement options could be a removable partial denture, a 4 unit fixed bridge or 2 dental implants. The temporary replacement of those teeth would depend on what permanent treatment you decided to do.
Hope this info is helpful...
Bryanna
Quote:
Originally Posted by burninghead
Hi everyone. I sure could use some help/advice.
Bryanna if your reading this, I read a similar question from a user that you replied to about a decade ago - if you could chime in I would be forever grateful.
I had a root canal in Sep 2019. The tooth never felt right after the procedure. Prior to the root canal it had a dull throbbing ache that kept getting worse. My endo was not aggressive and we did the wait and see approach however it never improved so we opted to root canal it. . It was retreated twice over the course of 2 months due to pain. He used a microscope and noted that he did not see any cracks in the tooth. He medicated it (with what I am not sure however he is very well known so I don't think it was the formescal stuff) It had no odor that I can say. I would like to hope a well known Endo would not be using this.
We completed the final process in December and the adjacent tooth #13 was throbbing so he felt that one might have always been the issue. We treated that tooth as well with a root canal. That tooth appears to feel ok
In treating #13 he did note it did not look well inside and there was dying pulp but no infection as of yet. #12 had inflamed pulp as well.
Sorry to my question. #12 has flared back up yesterday with pain now upon biting. I believe it's infected so I see the endo tomorrow and I also have an appointment with an oral surgeon regarding extraction and implant. I believe I will remove the tooth as I don't want any further endo treatment. Can an implant abutment be installed safely at the time of extraction in this situation? If not what is the general wait for installing the implant and lastly this tooth is visible from the front what goes in place of it while waiting?
Thank you again.
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