Originally Posted by parminides

Thank you so much for your detailed reply.

I remember that all four wisdom teeth were pulled at one time, and that the dentist had a lot of trouble with one. This was about twenty years ago, and I don't remember if he told me that he left a piece. But I haven't had any trouble from there.

I'm attaching an xray from last August of the #8 area of my mouth. See what you think about it.

I think I see what you suspect might be a crack in #19. It was an endodontist who said the tooth was cracked (after a general dentist said he suspected a crack). The endodontist did not show me on the xray. I was in pain and ready for some relief and wasn't too skeptical or interested in challenging him. If it was cracked, I have no idea how I got it.

I don't think the dark area on the right side of my mandible has gotten larger, although it's hard to say for sure since every x-ray has its own artifacts, etc. In September 2012, with the root tip still inside, the extraction site of #19 burst like a blister and drained completely. The swelling was gone and the area felt normal for the first time since the tooth had been pulled.

For a brief period it wasn't draining. During that period I noticed drainage coming from the dark area on the right side (which I've dubbed the mandibular swamp!). Apparently that drainagae source had been "drowned out" by the #19 drainage before then.

The general consensus is that the mandibular swamp is just a normal variation between my right side and left side. That seems strange to me, but that's what I've heard over and over. The way some people put it is that my nerve canal is wider on that side. It's very evident in the CT scans was well. It's like a cave on the right side.

One oral surgeon said the drainage I once perceived in that area might be discharge from a deep periodontal pocket. That same oral surgeon later said it might be a tumor or neoplasm and wanted to do a deep bone biopsy. I never let him do it because I lost confidence in that guy, who was really the only one who's seen me who ever thought that dark area might be bad.

Are you starting to understand that my mouth is a riddle wrapped in a mystery, surrounded by an enigma?

The track on the image of #19 pre-extraction (that I outlined in yellow) has bugged me to no end. Notice that there's overlapping bone to the left of it but none to the right. It just doesn't make any sense to me at all. Dentists have tried to explain to me that it's the angle of the camera, it's 3-D compressed to 2-D, etc. But no explanation convinces me that the overlapping bone should just abruptly stop like that.

When I was asking about the spread of infection, I just meant by the simple pathway of infection in #19 root channels spreading to mandibular canal and then traveling along the canal into the neck, just because there's a clear pathway. I've wondered why the infection didn't do that.

Originally Posted by parminides

Thanks for continuing to answer my questions. I really appreciate it.

I provided a side-by-side comparison of 3 xrays showing #8. The leftmost one was taken in May 2012, about a week after #19 had been pulled. (What in the world are those two dark, slanted lines at the top that seem to outline a small-scale version of Mt. Everest in my mouth?) The middle xray is from Aug 2012 and the last one is from Aug 2013.

After comparing them side-by-side myself for the first time this morning, I'm disappointed that there seems to be little if any bone regeneration since #8 was yanked.

I knew that the bone loss around #8 had endangered the adjacent teeth, but no one made it sound as dire as you do. The first oral surgeon thought an implant was possible if I had bone and soft tissue grafting when #8 was pulled, and possibly secondary grafting before the implant.

Another oral surgeon pulled #8 in Sep 2012. His records state that "Foundation graft placed 4-0 chromic gut." I'm almost certain that he didn't do a soft tissue graft.

What do you think needs to be done about the #8 vicinity after learning some more history and seeing a couple of more xrays?