[Illana]

Hello I had an old root canal (15 years old or so) on tooth #20. It started bothering me on Labor Day weekend and pain was pretty severe. I had it retreated a few weeks ago but its starting to flare up again. My endontist gave me a prescription also. Its starting to become very painful. My options are to have it retreated again, or to have it pulled and an implant put in. Because its closer to the front of my mouth I'm worried about aesthetics obviously. Also, I heard there is a nerve that is close to that tooth. I'm wondering if anyone has had an implant placed in this area (lower front region) and was it successful? Also, how long after having the tooth pulled would I have to wait until having the implant placed? My regular dentist has a periodontist that works at his office and he wants me to have her do the implants. I researched her on-line and she doesn't have very good reviews. I'm wondering if its better to have an oral surgeon place the implant? Lots of questions, and advice would be appreciated....

[Bryanna]

Hi Illana,

From what I recall, if I am correct, you have had several dental issues in various areas of your mouth that have caused or contributed to various infections, pain and nerve problems. Am I correct??

Anytime a root canaled tooth is extracted, there is going to be bacteria found in the ligament and jaw bone. The longer the rc tooth is present, the more advanced the disease in the surrounding area will become. The severity of the disease also depends on the individuals immune system. So some people may have more widespread problems than other people.

Anytime a root canaled tooth is replaced with a dental implant there is an increased risk of infection and/or implant failure due to the unfavorable changes that occur in the tissue and bone surrounding the root canaled or infected tooth. It is very hard to completely eradicate diseased bone that is not visible to the eye during the extraction of the tooth. So even under the best oral surgery care, there will always be some concern about residual bacteria living in that area of bone which can lead to infection, inflammation and nerve problems.

It does not matter how many times a tooth is root canaled, the status of the infected nerve tissue inside of the hundreds and hundreds of microscopic canals does not change for the better. There is no means of curing an infected tooth. Pain is often an indicator of a problem but no pain does not mean the problem has resolved when it comes to root canaled teeth.

I would suggest that you never go to a dentist who has a poor rating or reviews. Although these things are not always accurate, they should be a caution sign for those reading them.

I am going to attach a diagram of the microscopic canals called dentin tubules to show you just how many of these tiny canals are in each tooth. They are not accessible and do contain dead infected nerve tissue after the tooth has been root canaled. They are the brown lines that fill the dentin surface of the tooth and they are marked dentin tubules.

[Illana]

Hi Bryanna, Yes, I have had several issues - all caused by root canals but they have been further in the back of my mouth. This tooth concerns me because it is in the front of my mouth and I'm worried about how I would look. What is your opinion of dental bridges? It seems there is so much information now a days on implants, but perhaps dental bridges are phasing out? I've been looking into that and it seems there are several different types of bridges, they can be fixed to neighboring teeth in different ways. In your experience, what is the longevity of bridges?

Originally Posted by Bryanna

Hi Illana,

From what I recall, if I am correct, you have had several dental issues in various areas of your mouth that have caused or contributed to various infections, pain and nerve problems. Am I correct??

Anytime a root canaled tooth is extracted, there is going to be bacteria found in the ligament and jaw bone. The longer the rc tooth is present, the more advanced the disease in the surrounding area will become. The severity of the disease also depends on the individuals immune system. So some people may have more widespread problems than other people.

Anytime a root canaled tooth is replaced with a dental implant there is an increased risk of infection and/or implant failure due to the unfavorable changes that occur in the tissue and bone surrounding the root canaled or infected tooth. It is very hard to completely eradicate diseased bone that is not visible to the eye during the extraction of the tooth. So even under the best oral surgery care, there will always be some concern about residual bacteria living in that area of bone which can lead to infection, inflammation and nerve problems.

It does not matter how many times a tooth is root canaled, the status of the infected nerve tissue inside of the hundreds and hundreds of microscopic canals does not change for the better. There is no means of curing an infected tooth. Pain is often an indicator of a problem but no pain does not mean the problem has resolved when it comes to root canaled teeth.

I would suggest that you never go to a dentist who has a poor rating or reviews. Although these things are not always accurate, they should be a caution sign for those reading them.

I am going to attach a diagram of the microscopic canals called dentin tubules to show you just how many of these tiny canals are in each tooth. They are not accessible and do contain dead infected nerve tissue after the tooth has been root canaled. They are the brown lines that fill the dentin surface of the tooth and they are marked dentin tubules.

[Bryanna]

Illana,

Of course the aesthetic issues are important but aside from them, perhaps it's also important to keep a few things in mind when weighing out the risks of the two options which are to keep the root canaled tooth or extract it.

1) The tooth has been infected for 15 years and re treating it over and over again with rc procedures does not favorably alter the status of the infection.

2) Retaining this tooth means to retain the infection.

3) To extract the tooth means to remove the source of the chronic infection.

4) The dental branches of nerves and associated alveolar and lingual nerves that are intricately connected to this tooth will inevitably become irritated and possibly infected by this tooth. This chronic irritation increases the risk of extended nerve damage.

5) Those same nerves can be affected by the extraction of this tooth. However, the likelihood of extensive and permanent nerve damage following the extraction of the tooth is more likely to occur from the damage that was already caused by the infection and chronic irritation.

The longer a root canaled tooth retained, the more widespread the infection, inflammation and irritation will become. These are things to consider when making an informed decision about your tooth.

Dental bridges are not phasing out. They are done every day. There are certain criteria that are needed to do a bridge or do a dental implant:

For a permanent bridge:
Every permanent bridge needs anchor teeth to hold the bridge in place. You need healthy, ideally non root canaled, anchor teeth. These would be the teeth on either side of the extracted tooth. The anchor teeth need to be ground down so crowns can be put on them. Those crowns are soldered to a fake crown for the empty space. The anchor crowns are cemented onto the teeth that have been ground down.

Removable partial dentures:
These are appliances that look similar to orthodontic retainers. They have fake teeth soldered onto the appliance wherever there is a tooth missing in the arch. They are removed for cleaning and sleeping.

Dental implants:
These are titanium or zirconium posts that are surgically threaded into the jaw bone site of the extracted tooth. After a few months of placing the implant into the bone, a crown is fitted and cemented on the top of the post that sticks out of the gum. They are a foreign matter and if the patient is not healthy and/or has periodontal disease, and/or the bone is diseased or not adequate, the implants can become infected and fail.

The longevity of a permanent bridge depends on the health of the anchor teeth, the persons oral hygiene, the health of the other teeth and gums and how well the bridge fits. Under ideal conditions the cement underneath a permanent bridge can last 10-15 years, maybe longer.

Bryanna

Originally Posted by Illana

Hi Bryanna, Yes, I have had several issues - all caused by root canals but they have been further in the back of my mouth. This tooth concerns me because it is in the front of my mouth and I'm worried about how I would look. What is your opinion of dental bridges? It seems there is so much information now a days on implants, but perhaps dental bridges are phasing out? I've been looking into that and it seems there are several different types of bridges, they can be fixed to neighboring teeth in different ways. In your experience, what is the longevity of bridges?

[caroline2]

Just talking to a lady about which metal to do for implant. I've never had an implant and HOPE I never have to think about that. Maybe 10 yrs ago a 3 tooth bridge fell out of my mouth. It was a permanent bridge but didn't last a long time I guess.

I had a removable 3 tooth bridge made, and it's wonderful. Matches my gums and teeth and no one but me knows it's there. It anchors onto two teeth and it's been great.

I have a hard time thinking of metal implanted in my gums. Hard enough that I deal with a hip replacement implants, metal and plastic...thank goodness no infections.

I think too it's where one is in their life...younger, in the middle or older. I'm on the older end....and have learned to live simpler in everything.

[Bryanna]

Hi caroline,

The removable bridge that you have.... is it a nesbit partial appliance? This is a small retainer appliance that has a plastic tooth connected to plastic gum colored clasps that wrap around the adjacent teeth. Or do you have a 3 tooth plastic bridge that fills the space of the missing tooth and the anchor teeth are completely covered with plastic crowns?

A permanently cemented bridge less than 10 years old that just falls out does so for certain reasons. Some of those reasons are... tooth decay underneath the bridge, periodontal disease causing gum recession, bone loss and/or mobility of the teeth, or the cement loses it's adhesiveness due to bacteria getting in underneath the crowns.

Also, just for you information..... dental implants are not implanted into the gums. If they were, they would just fall out. Similar to your hip replacement prosthesis being screwed into your femur bone, dental implants are placed directly into the jaw bone.

Bryanna

Originally Posted by caroline2

Just talking to a lady about which metal to do for implant. I've never had an implant and HOPE I never have to think about that. Maybe 10 yrs ago a 3 tooth bridge fell out of my mouth. It was a permanent bridge but didn't last a long time I guess.

I had a removable 3 tooth bridge made, and it's wonderful. Matches my gums and teeth and no one but me knows it's there. It anchors onto two teeth and it's been great.

I have a hard time thinking of metal implanted in my gums. Hard enough that I deal with a hip replacement implants, metal and plastic...thank goodness no infections.

I think too it's where one is in their life...younger, in the middle or older. I'm on the older end....and have learned to live simpler in everything.

[caroline2]

Hi again, sounds like I have a nesbit...didn't know it's name...but it works good.

I guess for me, no matter how these implants are done, just doesn't feel right...the joint implants don't feel right but I did it....now deal with the mess of nerve damge and all I'm left with...there are good outcomes from what I hear but many with problems. As I said just happy no infection going on that I can tell. Scar tissue and lots of other stuff. Knowing these "parts" are in your body never goes away in one's mind.

[Bryanna]

Caroline,

Okay so you have a nesbit and it works for you.... that's great!

So when the permanent bridge came off, what did the dentist cover the anchor teeth with.... new crowns?

Bryanna

Originally Posted by caroline2

Hi again, sounds like I have a nesbit...didn't know it's name...but it works good.

I guess for me, no matter how these implants are done, just doesn't feel right...the joint implants don't feel right but I did it....now deal with the mess of nerve damge and all I'm left with...there are good outcomes from what I hear but many with problems. As I said just happy no infection going on that I can tell. Scar tissue and lots of other stuff. Knowing these "parts" are in your body never goes away in one's mind.