Hi Peter,

First let me clarify that all oral surgeons are not MD's.... at least not in the US. To obtain both degrees they have to attend medical and dental school as separate entities. Perhaps it is different where you live?

I am going to re post your questions and answer in bold type. Makes it easier to follow

<<<BTW what is your opinion regarding implants? I've done a bit research and even found a lot of info about all sorts of possible complications on web sites of oral surgeons that offer the service. So that solution is also not optimal.>>>

MY OPINION ON DENTAL IMPLANTS IS SIMPLY THIS. IMPLANTS ARE A VIABLE, HEALTHY OPTION FOR "CERTAIN INDIVIDUALS" PROVIDING THE SURGEON DOES AN EXCELLENT PLACEMENT AND THE RESTORATIVE DENTIST DOES AN EXCELLENT PLACEMENT OF THE CROWN PORTION.
A GOOD CANDIDATE WOULD BE SOMEONE WHO IS HEALTHY... NO MAJOR AUTOIMMUNE DISORDERS ... NO PERIODONTAL DISEASE.... NO INFECTED TEETH IN THEIR MOUTH..... NON SMOKER.
IN ANY INDIVIDUAL IT IS ALWAYS RISKY TO PLACE AN IMPLANT IN AN AREA THAT HAD A ROOT CANALED TOOTH AND/OR IN AN AREA NEXT TO A ROOT CANALED TOOTH. SIMPLY BECAUSE THE CHRONIC INFECTION FROM THE TOOTH CAUSES A NECROSIS TO OCCUR IN THE JAW BONE WHICH MAY OR MAY NOT BE ABLE TO BE REMOVED WHICH WOULD MEAN THAT THE HEALTH OF THAT BONE WOULD REMAIN COMPROMISED.
DENTAL IMPLANTS ARE ARTIFICIAL "SCREWS" THAT GET DRILLED INTO THE JAW BONE AND THE SURROUNDING BONE INTEGRATES WITH THE IMPLANT TO HOLD IT IN PLACE. IN ORDER TO BE SUCCESSFUL AND WITHOUT COMPLICATION IDEALLY THE BONE NEEDS TO BE HEALTHY AND THE PATIENT NEEDS TO BE HEALTHY.

<<<So what is it, to remove the tooth and have a hole there? Ok in my case maybe the #13 would be string enough to carry a bridge along with #15...>>>

IT IS NOT IDEAL TO LEAVE THIS SPACE AS THE TOOTH BEHIND IT WILL DRIFT FORWARD IN AN UNNATURAL PATTERN WHICH COULD RESULT IN PERIO POCKETING. IT COULD ALSO CAUSE THE BITE TO BECOME MISALIGNED.
IN YOUR CASE IT WOULD BE RISKY TO ANCHOR AN BRIDGE ON TO TOOTH #13 AS IT TOO IS ROOT CANALED WHICH MEANS IT IS IN A COMPROMISED STATE AND CHRONICALLY UNHEALTHY. WHEN THIS TOOTH DECIDES TO ACT UP AND NEEDS TO BE EXTRACTED, IF IT WERE THE ANCHOR TO A BRIDGE, THEN THE ENTIRE BRIDGE WOULD NEED TO BE REMOVED AND REMADE LONGER TO ACCOMMODATE THIS NEW MISSING TOOTH. IT IS NEVER RECOMMENDED TO USE A ROOT CANALED TOOTH AS AN ANCHOR FOR A BRIDGE AND ALL DENTISTS ARE AWARE OF THIS. HOWEVER, MANY WOULD DO THE BRIDGE ANYWAY.

<<<And one more question regarding root canals. I understand why they are not good - not being able to clean the the bacteria inside microscopic canals and just trap it in there. But would you say there are bad and less bad root canals? >>>>

SO GLAD YOU HAVE UNDERSTOOD MY EXPLANATION ABOUT THE TRAPPED BACTERIA! )
ARE THERE BAD AND LESS BAD ROOT CANALED TEETH?? NOT REALLY BECAUSE THEY ARE ALL UNHEALTHY. DEPENDING ON THE PERSONS OVERALL HEALTH SOME RC TEETH MAY POSE A MORE SERIOUS THREAT TO THE PATIENTS HEALTH THAN OTHERS. SOME ARE OBVIOUSLY MORE INFECTED THEN OTHERS FOR VARIOUS REASONS BUT THAT IS NOT A GOOD GAUGE TO DETERMINE HOW DETRIMENTAL THEY CAN BE. SOME HAVE MORE OBVIOUS SYMPTOMS THAN OTHERS AND AT DIFFERENT STAGES OF THE INFECTION. I HAVE SEEN HUGE ABSCESSES FROM RC TEETH THAT LITERALLY SPREAD THE ENTIRE LENGTH OF THE QUADRANT REQUIRING THE PATIENT TO HAVE NOT JUST THE ROOT CANALED TOOTH REMOVED BUT ALL OF THE TEETH IN THAT QUADRANT ALONG WITH A GOOD PORTION OF THE JAW BONE.... AND SOME OF THESE PATIENTS HAD ONLY MINOR FLEETING SYMPTOMS AND THEIR INFECTION WAS UNEXPECTEDLY PICKED UP ON A RADIOGRAPH DURING A ROUTINE EXAM.

<<<Over here, the dentist usually tries to perform the treatment, but sometimes (in my case actually quite often) the canals are unpassable and in that case, an endodontist performs the procedure using a microscope. In fact, 4 out of my 6 root canals were performed by the endodontist. The one possibly causing trouble right now was not.>>>

GENERAL DENTISTS WILL TELL A PATIENT THAT THE ENDODONTIST HAS SOME MAGIC MICROSCOPE AND PERHAPS POWERS TO MAKE A TOOTH HEALTHY AGAIN. THE FACT IS THAT THE MICROSCOPE CAN ONLY PICK UP THE BACTERIA THAT IS LEFT BEHIND IN THE VISIBLE CANALS. THERE IS NO VISIBLE ACCESS TO THE CURVY, NARROW MICROSCOPIC CANALS. SO THOSE CANALS WILL ALWAYS CONTAIN NECROTIC NERVE TISSUE.
THE DIFFERENCE BETWEEN THE ENDODONTIST AND THE GENERAL DENTIST IS ADDITONAL EDUCATION TO TEACH HOW TO UTILIZE VARIOUS EXPENSIVE INSTRUMENTS TO GET INTO LARGE CANALS THAT MAY BE SOMEWHAT CALCIFIED OR IRREGULAR IN ANATOMY. ANOTHER DIFFERENCE IS THE ENDO DENTIST DOES IT FOR A LIVING SO HE USUALLY DOES THE PROCEDURE QUICKER. THE LAST DIFFERENCE IS THE ENDO DENTIST CHARGES MORE FOR THE PROCEDURE..... BECAUSE HE'S A "SPECIALIST". :/
THE END RESULT IS BASICALLY THE SAME SIMPLY BECAUSE OF THOSE DOG GONE MICROSCOPIC CANALS! AND HUGELY BECAUSE ALL TEETH REQUIRE NUTRITION FROM THE BLOOD VESSELS TO BE HEALTHY... THE RC PROCEDURE SEVERS THE BLOOD VESSEL AT THE APEX OF THE TOOTH RENDERING THE TOOTH NON VITAL. ANYPLACE IN OR ON THE BODY WHERE THERE IS NO LONGER CIRCULATION OF BLOOD WILL END UP VERY SICK.

I really do not like giving people this crappy news. I just wish you were told these things prior to having the teeth root canaled because your replacement options at that time would not have been compromising as they are now.

The replacement options for you would be dependent on which teeth you have removed and if you considered have the other rc teeth removed as well. If you wanted the least invasive replacements then you may be a candidate for removable partial dentures which would replace teeth on both side of an arch at one time. You may be able to have bridged made to replace teeth depending on what teeth would be missing and what teeth would be the anchors.

Bryanna