Hi woodfly,

Glad to hear that you had an abscessed tooth removed and as you now know, not all infections show up radio graphically.

Thank you for posting the xray.

The filling material on the molar looks to be amalgam and there are light shadows underneath 2 areas of the filling that may be decay. They are very light and may show up more clearly on a different xray called a bite wing.

The filling material on the root canaled pre molar appears to be metal, may be amalgam or gold on the distal portion and composite or temporary material on the remainder of it. There is a void, most likely decay, in the center portion of this tooth where the access hole was made to do the root canal procedure. It is the half moon shape you see in the center where the root canal filling material (gutta percha) begins. This area of decay is progressive.

Sometimes the angle of which the film was taken is off a bit and the anatomy is distorted. However, on this xray both of these teeth appear to be in close proximity to the sinus. There could be a fracture or something happening at the apex of the rc premolar and it's questionable if there is pathology in the bone.

There is also possible decay interproximally on both the mesial and distal of the first premolar.

What has your dentist diagnosed from this xray and from his clinical examination?

Bryanna

Long story short, this upper tooth had a root canal that was infected. I got a root canal retreat about 3 weeks ago. I will be going to a dentist next week to get my fillings. However from what I understand, root canals don't completely get rid of the infection? I'm considering extracting it because I think it's affecting my sinuses.

I am attaching two sets of photos. The pano is taken before any retreats or extractions

The second picture are taken AFTER he did the "most" of the root canal (he cleaned out the tooth or whatever but didn't finish putting in the material)

I posted my pano a while back and you said that my bottom left tooth had an infection and possible fracture. You were right. In that case, doing a root canal would have done nothing. I almost did a root canal on that bottom tooth. I feel like perhaps this is possibly the same case for my upper tooth? That that root canal retreat is gonna do nothing and it would be better to extract it?

Just by looking at the xrays, do you think an extraction or root canal is better for my upper right?

Attached Images

	Martin Haung.jpg (130.1 KB, 241 views)
	Dentist Xrays.jpg (152.3 KB, 164 views)

Woodfly,

Thanks for posting all of the xrays.

Both root canaled teeth are infected because the dentin tubules contain infected necrotic nerve tissue. In addition to that fact, they both show pathology on the radio graphs.

The lower left molar has a large area of bacterial pathology around the mesial (front) root. The root of the upper right premolar is either in close proximity or directly into the sinus. The sinus, is blocking the view of the pathology around the apex of the tooth. It is also blocking the health of the molar behind this tooth.

If you look at the panorex and compare the posterior area of your upper right with your upper left, you will see the sinus hovering over and around your premolar and molar areas on both sides. Your upper right sinus area is considerably darker more radiolucent looking compared to your left. When this radio graphic finding is seen in an area where there is a root canaled or infected tooth, it generally indicates proliferation of bacteria and inflammation from that root canaled or infected tooth.

The pressure from that bacteria and inflammation could cause headaches, sinus pressure or infection, eye, ear, gland problems, and so on.

Bryanna

Do you have idea if that pressure shows up on an MRI?

Woodfly,

Pressure does not show up on any radio graph or scan.

If you are going to have additional diagnostic tests, then a dental 3D scan instead of an MRI would be best.

Bryanna