Hi Bryanna,

The tooth is #30... And I believe the endodonist has said that the bone is healthy. That could be why he might want to do the Apicoectomy, as I say, I will talk with him on Wednesday this week. He wasn't real clear about all of this when I saw him in January.....I want to decide soon after I hear from him...
My hesitancy is first due to this being my first ( hopefully my last ) and secondly hearing that many people I speak with just have "holes" and no implants...a few people I know have had bridges. If it is well and fine without an implant, I could be satisfied without one for a while to see how the experience is...chewing, etc...
I have also been wondering about the nerves in there and that the nerves aren't
going to be affected. I hear that this can be a problem for some people.
So, my attitude in being hesitant is due to trying to be patient in hearing about the information that I am finding out as well as reading your advice. One question, doesn't my dentist fit me for a crown after I get the implant. The oral surgeon's office was saying that this happens before I get an implant in my mouth... Thanks, Willy P.S. When I had prostate cancer 9.5 years ago it took me about 3 months to decide to have radiation treatments over the surgery

Hi willy,

Tooth #30 is your lower right first molar. For those that may be following this thread.

This statement is not intended to be argumentative or adversary to what your dentist is telling you. But the fact is: the bone is never healthy surrounding a root canaled tooth due to the proliferation of the bacteria from the tooth through the dentin tubules and periodontal ligament. The degree or severity of the necrosis in the bone from the chronic infection depends on the overall medical and dental health of the person and how long the tooth has been infected. Keep in mind that the tooth has been infected since some time prior to the first root canal procedure. The severity of infection in the jaw bone is often not seen on the radio-graph unless it is very widespread.

Therefore, his statement about the bone being healthy is not exactly accurate. Doing the apico under any circumstances, even in healthy bone, does not alter the procedure to be one that has the ability to cure an infected tooth. An apico is a surgical root canal with the only difference being that the entry is from the bone rather than the occlusal (biting) surface of the tooth.

Your hesitancy is typical and totally warranted especially since you are not being completely informed by your dentists about the temporary outcome (if that) of these procedures nor the systemic consequences of retaining this tooth. I cannot stress enough that the patient is the one who guides the dentist into disclosing all of the treatment options. The more hesitant the patient is to remove their sick tooth, the more reluctant the dentist is to disclose certain things until the time comes when the inevitable starts to happen. I know that sounds totally stupid.... and I wish things were different. But after 35 years in dentistry I can tell you that this is how it is done the majority of the time. The patient that receives the most thorough explanations and the best comprehensive care are those that are well informed about the truth of these dental procedures.

Tooth #30 is a tooth that we use to chew with. It also keeps #31 from drifting forward and tooth #3 above from drifting downward. Depending on your personal occlusion/bite you may not have to be concerned about #3 as it may be occluding/biting against teeth 29 and/or 31. Or maybe you are missing tooth #3???

You may be a candidate for a permanent bridge from teeth # 31 to 29. Providing you have both of those teeth still present in your mouth and they are healthy. I that is the case, then you could opt out of doing the dental implant.

The general dentist can take some preliminary impressions of your mouth prior to removing #30. But the final impressions are not done until after the implant is placed and has integrated with the bone for a few months. The crown is fabricated after that.

I commend you on taking your time to make your decision about the treatment for prostate cancer!!! All too often people make rash decisions out of fear. In most cases we have the time to think, to learn and to make a clear decision that we believe is in our best interest.

Bryanna

Hi Bryanna,

This morning I saw the endodonist who took another x-Ray. He has sent me to the oral surgeon. He didn't suggest a apicoectomy which sounds that it wouldn't help much at all since it would be just another kind of root canal, as you wrote before. I am sure now to go with an extraction.
He's not sure the cause of the sensitivity,( i.e. pain when i press on the tooth and gum). Possibly he says the tooth is cracked. From reading back in your emails, I wonder if you would believe it could be the nerves. In any event, I want the tooth extracted at this point. However, I am not sure about having an implant right now. Possibly to wait a few months! Any thoughts about the immediacy of the implant if I am thinking of possibly doing it within a 3 or 4 months ( or at all)...the cost is high...BTW, all my teeth are in my mouth...no other extractions, etc.
Thanks, willy

Hi willy,

Well I am relieved to hear that the endodontist agrees to remove that tooth and that he confirmed what I have been saying here. I think he realized you are concerned about the (lack of ) long term results of re treating this tooth.

It is common for a patient to complain of sensitivity or a soreness when they press on a root canaled tooth especially when it has obvious radio graphic pathology. Many dentists tell the patient.... gee, that's unusual or don't know why that is happening..... simply because they want to stay with the story that the root canal procedure removes all the vitality from the tooth making it impossible to feel any sensation. The truth is, the microscopic canals were never cleaned out so the nerve tissue that resides in those canals is now necrotic and inflamed. Anytime you have necrotic and/or inflamed tissue there is going to be some degree of discomfort or soreness. Along with that, the tooth still sits in a live periodontal ligament and live bone... so any inflammation pertaining to that (non vital) tooth is going to cause discomfort. Make sense??

It is possible for the tooth to also be fractured. This is a very common occurrence with root canal teeth as they are much more fragile after the rc procedure leaving them susceptible to decay and fracturing.

I would suggest to remove the tooth and if the bacteria can be removed completely and the bone scraped clean, then place a bone graft in the socket to help encourage and preserve the integrity of the growth of new bone. After one year, the bone will start to recede if you have not placed an implant. The amount of recession is dependent on the individual case.
Allow the extraction site to heal for 3-6 months as that is how long it takes for your own bone to moderately integrate with the graft material. In that time frame you can discuss your replacement options with your general dentist. The bone will be evaluated for solidity, depth, height and width if you choose to have the dental implant. You may opt to do a 3 unit permanent bridge or nothing at all.

It is nice to hear that other than this tooth, you have a full set of natural teeth! I hope you get to keep each and every one of them forever!!

Bryanna

Hi Bryanna,

Thanks for all of your guidance and information, and patience... Making the decision to go ahead with an extraction is difficult. I will let you know what happens!
Willy