here is the xray, if you don't mind giving me your advice

I just spoke to the endo on the phone and he said he had no plans of doing an apicoectomy, that he was confident the tooth could have a standard RCT. I told him I had to be 100% sure walking in to his office and he understood. He said it is my choice when I would go in but he said it's unlikely to settle on it's own. I still am hopeful....

nukuspot,

Thanks for posting the xray.

Tooth #7 your upper right lateral is the tooth currently in question. I will just list the obvious on this xray as it is being presented here:

**The severity in the resorption of the root of this tooth is extensive as you can see that just by comparing it to the adjacent teeth. It almost looks like a deciduous tooth but it is your adult tooth.

**The large canal is mostly calcified. There may be a hairline size canal inside of this tooth but it does not appear to be large enough to thread an instrument inside of it without extensive drilling. The only reason a dentist would drill into this tooth is to reach the end of the root and here's why. The exception to the calcification is at the very top of the root where you can see what looks like a bump coming out of it just to the left of the center. That bump may be a cyst forming from the smidgen of nerve tissue that appears to be inside the tooth at the tip of the root directly below the bump.

**There is bone loss on the distal (left side) of this tooth that stems from the area of the bump. You can actually follow a line from the bump at the top of the root down the left side of the tooth to the crest of the bone. This area appears darker than the other side because there is pathology, probably bacteria from the smidgen of nerve inside the tooth at the top of the root which is causing the bump and causing the bone loss.

The bone loss, the bump and the bacteria did not happen over night. The symptoms probably occurred suddenly because the inflammation has built up to the point that the periodontal ligament is irritated. However, the problem began awhile ago. If you had had anterior periapical xrays of this tooth over the last 3-5 years, the onset of this problem may have been picked up sooner.

The other thing worth mentioning is that the bone above #7 and 8 on this radio graph appears less dense than normal. It could be the angle that this film was taken but it could also be a thinning of the bone that has occurred over time possibly due to the trauma of the ortho. It is important to know about the bone rather than be surprised later on. So to be sure, it would behoove you to have periapical xrays of all of your upper front teeth to see a broader view of the bone. Having the lower anterior xrayed also would be a good idea too if you have not had them done in the last 3 years.

Due to the calcification of this tooth, just like #11, the chance of a perforation is possible. Perhaps you should talk to the endodontist about the likelihood of that... also how does he plan on opening up and instrumenting this tooth due to the calcification ... what is the bump at the tip of the root ..... why is the ligament so dark on the distal of the tooth .... and why does the bone above 7 and 8 look less dense (indicated by the dark color of the bone).

Bryanna

Hi Bryanna,

Thank you.

I know he said (in regards to the calcification) that if he could not open up the area manually they have a chemical that dissolves the calcification. I wonder why they did not do that with #11 (different endo) but it was only 4 years ago.

I hate the idea of chemicals, BTW. I am sure it is something awfully toxic. But that was what he said so I am sharing it with you.

My pain is pretty bad right now. I have 2 appointments with holistic dentists tomorrow to see if they can offer any other option other than RCT or extraction for this tooth. If not I am still unsure what to do but I cannot live like this either. The dentists I see tomorrow both do implants so I can at least ask them about the bone quality if I do extract this tooth either now or at a later date.

Unfortunately I cannot see my usual dentist because this is the one time he takes a 2 week vacation! This was awful luck. But I am seeing people that he refers to a lot. His assistant gave me the idea since I can't wait 2 weeks more to decide.

here is the same picture I posted in the other thread. It was taken of the apico #11 but the other lateral (#10) does show. Can you infer anything about the density of the bone on the left upper side from this? At this moment I do not have any of my two upper front teeth but I will speak to my dentist about this very soon.

the top of this lateral seems to have the same weird bumpy shape as #7, doesn't it? However this one is asymptomatic and doesn't look as calcified. As a layperson that is all I can infer. I would love your opinion.

nukuspot,

The bump is different in #7 compared to #10. The bump on #10 is actually a piece of the root tip and there doesn't seem to be any radio graphic pathology other than some bone loss on both the mesial and distal sides of the tooth. The mesial or left side of #10 looks to have a deeper pocket than the distal, right side. Have you ever had periodontal probing done?

Tooth #7 has possible pathology at the apex at the site of that bump and in the xray of #7 you can trace the pathology down along the periodontal ligament to the ginginval crest of bone. Tooth #10 does not appear to have that problem and it also does not appear to be calcified like #7.

The bone density in general appears thinner or less dense than usual. But again it could be the angle of the film.

Bryanna

Hi again,

Yes I have had periodontal probing, quite recently actually! Nothing abnormal. Everything is 1s, 2s, a few 3s but those were in the back molars.

will the implant/extraction dentist I see be able to tell me about the bone density looking at my CBCT scan? That is not possible to post here but I do have one. Or are there other tests he can do?

I still have no idea what to do.

nukuspot,

Oral surgeons or dentists who have extensive training as well as extensive experience in oral surgery will be able to read a dental CBCT scan very efficiently. General dentists do not have the depth of knowledge about reading these scans like an oral surgeon does so their view of it may be a bit skewed.

I don't know if your dentist who performs extractions and implants is well versed in reading dental CBCT scans or not.

I know this is all quite stressful for you. I feel terrible that you're going through this. If your parents had any informed idea of what was happening during the ortho, they probably would have questioned it. There is no desirable remedy to your problems with tooth #7 or 11. Meaning anything shy of extracting them is a band ade and no one can tell you exactly what will take place or when it will take place if you retain those teeth. The prospect of having extractions and dental implants and all that goes with it, is also very stressful.

It would behoove you to know what the current health of the bone is and if it is okay then removing those teeth before infection and bone loss occur would be to your advantage....considering the overall scheme of things.

Bryanna




nukuspot;1163497]will the implant/extraction dentist I see be able to tell me about the bone density looking at my CBCT scan? That is not possible to post here but I do have one. Or are there other tests he can do?

I still have no idea what to do.[/QUOTE]