Hi Stacy,

You are very fortunate to have only a few teeth with restorations! That's really great.

Ten years ago, prior to the root canal, did you consult with an Ear Nose and Throat doctor? If so, was a scan of your sinuses done? I'm asking because it sounds like you were having a chronic inflammatory issue in that area of your sinuses. It may or may not have been related to the tooth and a sinus scan may have been helpful in the diagnosis prior to having the root canal.

As part of your decision making, it's important that you become informed about the condition of this tooth once it was root canaled. During that procedure, the blood supply to the tooth gets severed which causes the live nerve tissue inside of the tiny canals to die. This tissue cannot be removed and it becomes infected. So this tooth has been harboring infected, necrotic tissue for 10 years. Re treating with another root canal or having an apicoectomy surgery will not alter the condition of this tooth because these canals are not accessible.

Keeping in mind the above information, the second concern has to do with the location of the tooth in relation to the sinus. There is always a high risk that the infection will proliferate from the tooth into the sinuses. If that has occurred, then there is already a perforation in the sinus from the bacteria.

Small sinus perforations generally heal on their own. Larger ones can be mended and again, will heal. The perforations that take longer to heal are those that are associated with an infection. It can be difficult to eradicate the infection from the sinus.

It is imperative to keep this information in mind as you may or may not be informed of it by your dentist. Sometimes an xray or a dental scan can show if there is a tooth/sinus communication, etc. Other times, the communication is so small that the only time it is actually seen is when the tooth is removed.

There are a few replacement options for this tooth. One would be a conventional 3 unit fixed bridge which would involve cutting down each adjacent tooth. A second option in your case may be what is called a 3 unit fixed onlay bridge. This is similar to the first option with the exception that the adjacent teeth are only cut down minimally as opposed to severely. The adjacent teeth would have porcelain onlays (similar to small/shallow biting surface fillings) and a fake porcelain tooth would be fabricated in the middle of the two onlays. This is the least invasive replacement option and not every dentist is very experienced in doing this type of bridge but those that are, do them very well. The third option would be to place a dental implant that may or may not require a graft, sinus repair and lift.

I know this is scary and you are very concerned about making the right decision. I can tell you without any doubt that this tooth is harboring necrotic nerve material inside those tiny canals. So one real issue is the longer this tooth is present, the more likely it is for the bacteria to proliferate into the sinus. Another important concern is how will this chronic inflammation affect your overall well being.

Let me know your thoughts........

Bryanna