[kelly123]

Thanks for reading this. I have had plenty of issues with my teeth; crowns and braces and one implant bridge for molars.
About ten years ago, I SWEAR my front tooth (crowned) moved forward and I pushed it back. I then had braces and had the crowns replaced two years ago. One front tooth has always felt "twingy" and I kept asking the dentist if the root was fractured. He kept saying no; he saw nothing. Last April, the pain was HORRIBLE and i had an emergency root canal. The endontist said that the tooth had a little side canal and treatment was "questionable." When he got into the tooth, though, he said that the nerve/tissue was dead and he was confident that my problems were ending.
I had pain again after (not terribly severe) and went back to him and my regular dentist. I said that I must be crazy but I really felt the root was somehow fractured. They both said that the xray showed it was healing and that it wouldn't heal if the root was fractured. Is this true? It still twinges in pain. My regular dentist says the canal is just overfilled. HELP???? Any advice? Also, my four front teeth are crwons so I am thinking I would opt for an implant bridge. Any experience with those?
Thanks for reading.

[Bryanna]

Hi Kelly,

Yes, I have lots of experience with this type of dental case.

I am going to re post some of your post and reply in bold type. This will help to clarify some things...

<<About ten years ago, I SWEAR my front tooth (crowned) moved forward and I pushed it back. I then had braces and had the crowns replaced two years ago. One front tooth has always felt "twingy" and I kept asking the dentist if the root was fractured. He kept saying no; he saw nothing. Last April, the pain was HORRIBLE and i had an emergency root canal. The endontist said that the tooth had a little side canal and treatment was "questionable." When he got into the tooth, though, he said that the nerve/tissue was dead and he was confident that my problems were ending.>>

THE ORIGINAL SYMPTOMS THAT YOU HAD ON THIS FRONT TOOTH INDICATE THAT THE NERVES WERE DYING AND THE PROBLEM WAS NOT PICKED UP ON THE XRAYS OVER THOSE 10 YEARS. THE ORTHODONTIA AND RESTORATIVE WORK THAT YOU HAD DONE ON THIS TOOTH HAVE EXACERBATED THE ORIGINAL PROBLEM THAT WAS CAUSING THE NERVES TO DIE. IF YOU HAVE ANY HISTORY OF TRAUMA TO THIS TOOTH, EVEN BITING INTO SOMETHING REALLY HARD WHEN YOU WERE YOUNGER COULD HAVE TRAUMATIZED THE TOOTH ENOUGH TO CAUSE THE NERVES TO DIE. FRACTURES IN TEETH ARE NOT ALWAYS VISIBLE CLINICALLY OR RADIO-GRAPHICALLY. SO IT IS VERY POSSIBLE THAT THE TOOTH IS FRACTURED.
AS FAR AS THE ENDO STATING HIS CONFIDENCE IN THAT THE "PROBLEMS" WITH THIS TOOTH WERE GOING TO IMPROVE AFTER THE ROOT CANAL WAS DONE IS A BIT MISLEADING IN THAT THE RC PROCEDURE DOES NOT MAKE AN UNHEALTHY TOOTH HEALTHY AGAIN. THE PROCEDURE IS DONE TO RETAIN, NOT CURE, A NON VITAL AND UNHEALTHY TOOTH FOR AN UNCERTAIN AMOUNT OF TIME. THERE ARE MANY BIOLOGICAL CHANGES THAT OCCUR IN A NON VITAL RC TOOTH AS WELL AS IN THE BONE SURROUNDING THAT TOOTH THAT CAN CAUSE OR CONTRIBUTE TO A MORE WIDESPREAD SYSTEMIC PROBLEM.

<<I had pain again after (not terribly severe) and went back to him and my regular dentist. I said that I must be crazy but I really felt the root was somehow fractured. They both said that the xray showed it was healing and that it wouldn't heal if the root was fractured. Is this true? It still twinges in pain.>>

PAIN IS NOT THE BEST INDICATOR FOR MANY DENTAL PROBLEMS AS MOST DENTAL ISSUES ARE PAIN FREE UNTIL THE PROBLEM BECOMES SEVERE OR MORE WIDESPREAD. IT IS NOT UNCOMMON TO HAVE PAIN OR DISCOMFORT WITH AN RC TOOTH FOR SEVERAL REASONS BUT ONE OBVIOUS ONE IS BECAUSE THE TOOTH IS SITTING IN A LIVE LIGAMENT AND LIVE JAW BONE. SO THE CHRONIC INFLAMMATION AND BACTERIA THAT LIVES INSIDE AND OUTSIDE OF THE RC TOOTH IS IRRITATING TO THE VITALITY THAT SURROUNDS THE TOOTH. ALSO, A FRACTURED RC TOOTH WILL BE MORE SYMPTOMATIC THAN ONE THAT IS NOT FRACTURED.
WHEN A DENTIST SAYS THAT THE RC TOOTH LOOKS LIKE IT'S "HEALING" OR APPEARS TO BE "FINE" THIS DOES NOT MEAN THE TOOTH LOOKS HEALTHY. IT JUST MEANS THAT THE TOOTH LOOKS LIKE IT SHOULD AFTER HAVING A ROOT CANAL.

<< My regular dentist says the canal is just overfilled. HELP???? Any advice?>>

AGAIN OVERFILLS OF RC TEETH ARE FREQUENTLY SEEN BUT THEY ARE NOT A BENIGN ISSUE AS THEY ARE OFTEN PASSED OFF TO BE. YOUR ENDO SHOULD HAVE INFORMED YOU THAT HE OVERFILLED THE TOOTH. THAT OVERFILL OF MATERIAL IS A CONSTANT IRRITANT AND ANOTHER AREA FOR BACTERIA TO GROW. A GOOD EXAMPLE WOULD BE.... A SPLINTER EMBEDDED IN A KNUCKLE ON YOUR FINGER. TO THINK OF THAT HAS SOMETHING ACCEPTABLE WOULD BE.... UNACCEPTABLE.

<<Also, my four front teeth are crwons so I am thinking I would opt for an implant bridge. Any experience with those?>>

DUE TO THE LONGEVITY, CHRONIC AND CURRENT PROBLEMS WITH THIS TOOTH, CHANCES ARE THE BONE IS GOING TO BE COMPROMISED EVEN AFTER THE TOOTH IS REMOVED. BONE GRAFTING AND INTEGRATION OF THE DENTAL IMPLANT WILL ONLY BE SUCCESSFUL IF THERE IS HEALTHY ADEQUATE BONE TO PUT IT INTO. ARE ANY OF THE OTHER FRONT TEETH ROOT CANALED?

Bryanna

[kelly123]

Originally Posted by Bryanna

Hi Kelly,

Yes, I have lots of experience with this type of dental case.

I am going to re post some of your post and reply in bold type. This will help to clarify some things...

<<About ten years ago, I SWEAR my front tooth (crowned) moved forward and I pushed it back. I then had braces and had the crowns replaced two years ago. One front tooth has always felt "twingy" and I kept asking the dentist if the root was fractured. He kept saying no; he saw nothing. Last April, the pain was HORRIBLE and i had an emergency root canal. The endontist said that the tooth had a little side canal and treatment was "questionable." When he got into the tooth, though, he said that the nerve/tissue was dead and he was confident that my problems were ending.>>

THE ORIGINAL SYMPTOMS THAT YOU HAD ON THIS FRONT TOOTH INDICATE THAT THE NERVES WERE DYING AND THE PROBLEM WAS NOT PICKED UP ON THE XRAYS OVER THOSE 10 YEARS. THE ORTHODONTIA AND RESTORATIVE WORK THAT YOU HAD DONE ON THIS TOOTH HAVE EXACERBATED THE ORIGINAL PROBLEM THAT WAS CAUSING THE NERVES TO DIE. IF YOU HAVE ANY HISTORY OF TRAUMA TO THIS TOOTH, EVEN BITING INTO SOMETHING REALLY HARD WHEN YOU WERE YOUNGER COULD HAVE TRAUMATIZED THE TOOTH ENOUGH TO CAUSE THE NERVES TO DIE. FRACTURES IN TEETH ARE NOT ALWAYS VISIBLE CLINICALLY OR RADIO-GRAPHICALLY. SO IT IS VERY POSSIBLE THAT THE TOOTH IS FRACTURED.
AS FAR AS THE ENDO STATING HIS CONFIDENCE IN THAT THE "PROBLEMS" WITH THIS TOOTH WERE GOING TO IMPROVE AFTER THE ROOT CANAL WAS DONE IS A BIT MISLEADING IN THAT THE RC PROCEDURE DOES NOT MAKE AN UNHEALTHY TOOTH HEALTHY AGAIN. THE PROCEDURE IS DONE TO RETAIN, NOT CURE, A NON VITAL AND UNHEALTHY TOOTH FOR AN UNCERTAIN AMOUNT OF TIME. THERE ARE MANY BIOLOGICAL CHANGES THAT OCCUR IN A NON VITAL RC TOOTH AS WELL AS IN THE BONE SURROUNDING THAT TOOTH THAT CAN CAUSE OR CONTRIBUTE TO A MORE WIDESPREAD SYSTEMIC PROBLEM.

<<I had pain again after (not terribly severe) and went back to him and my regular dentist. I said that I must be crazy but I really felt the root was somehow fractured. They both said that the xray showed it was healing and that it wouldn't heal if the root was fractured. Is this true? It still twinges in pain.>>

PAIN IS NOT THE BEST INDICATOR FOR MANY DENTAL PROBLEMS AS MOST DENTAL ISSUES ARE PAIN FREE UNTIL THE PROBLEM BECOMES SEVERE OR MORE WIDESPREAD. IT IS NOT UNCOMMON TO HAVE PAIN OR DISCOMFORT WITH AN RC TOOTH FOR SEVERAL REASONS BUT ONE OBVIOUS ONE IS BECAUSE THE TOOTH IS SITTING IN A LIVE LIGAMENT AND LIVE JAW BONE. SO THE CHRONIC INFLAMMATION AND BACTERIA THAT LIVES INSIDE AND OUTSIDE OF THE RC TOOTH IS IRRITATING TO THE VITALITY THAT SURROUNDS THE TOOTH. ALSO, A FRACTURED RC TOOTH WILL BE MORE SYMPTOMATIC THAN ONE THAT IS NOT FRACTURED.
WHEN A DENTIST SAYS THAT THE RC TOOTH LOOKS LIKE IT'S "HEALING" OR APPEARS TO BE "FINE" THIS DOES NOT MEAN THE TOOTH LOOKS HEALTHY. IT JUST MEANS THAT THE TOOTH LOOKS LIKE IT SHOULD AFTER HAVING A ROOT CANAL.

<< My regular dentist says the canal is just overfilled. HELP???? Any advice?>>

AGAIN OVERFILLS OF RC TEETH ARE FREQUENTLY SEEN BUT THEY ARE NOT A BENIGN ISSUE AS THEY ARE OFTEN PASSED OFF TO BE. YOUR ENDO SHOULD HAVE INFORMED YOU THAT HE OVERFILLED THE TOOTH. THAT OVERFILL OF MATERIAL IS A CONSTANT IRRITANT AND ANOTHER AREA FOR BACTERIA TO GROW. A GOOD EXAMPLE WOULD BE.... A SPLINTER EMBEDDED IN A KNUCKLE ON YOUR FINGER. TO THINK OF THAT HAS SOMETHING ACCEPTABLE WOULD BE.... UNACCEPTABLE.

<<Also, my four front teeth are crwons so I am thinking I would opt for an implant bridge. Any experience with those?>>

DUE TO THE LONGEVITY, CHRONIC AND CURRENT PROBLEMS WITH THIS TOOTH, CHANCES ARE THE BONE IS GOING TO BE COMPROMISED EVEN AFTER THE TOOTH IS REMOVED. BONE GRAFTING AND INTEGRATION OF THE DENTAL IMPLANT WILL ONLY BE SUCCESSFUL IF THERE IS HEALTHY ADEQUATE BONE TO PUT IT INTO. ARE ANY OF THE OTHER FRONT TEETH ROOT CANALED?

Bryanna

Thanks so much for the detailed response; much-appreciated! Ironically, I asked about antibiotics after this tooth was RC. The endo said that my infection was nill and hadn't spread into the bone as I had anticipated. NO antibiotics were even given. 6 months prior to the rc, I developed a fistula that I did pop.
I have an appointment with my dentist again in two weeks. One other front tooth is RC and all four are crowns. How bad are partials if I go that route? I am not as concerned about finances as I am aesthetics to be blunt. My dentist does the crown work for the implant. I had one for two molars; very happy with them. THANKS again: you rock!!!

[Bryanna]

Kelly,

Whether or not you had antibiotics at the time of the root canal or not is irrelevant as there will always be bacterial infection inside of the inaccessible hundreds of microscopic canals called dentin tubules. I will attach a diagram for you to see just how loaded the tooth is with those tiny canals. When a dentist says that the rc tooth is not infected, they are referring to an abscess, not to the bacteria that resides in the dentin tubules.

The formation of the fistula indicates the severity of the infection as that is a tract of bacteria that has burrowed a path from the interior of the tooth, into the jaw bone and through the gum. The fistula is just the outlet from the path of infection, similar to the head filled pus on top of a cyst on your skin. The difference in the two is that the bacteria from the tooth is in the bone, whereas a cyst may not be much deeper than the skin.

The infection from root canaled teeth can easily spread to the adjacent teeth. These teeth are also not ideal as anchors for permanent bridge work because they are not healthy and the added pressure of holding a bridge causes them to break down even further. Bridgework that is attached to rc teeth will always be compromised for that reason.

Removable partial dentures take some getting use to. Some people do well with them while others struggle a bit. Dental implants when placed in healthy solid bone can last a lifetime. Dental implants placed in unhealthy bone and/or inadequate bone can be a chronic problem contributing to further bone loss.

You said you have one implant for two molars. Is that a single tooth implant next to a single tooth crown or are those 2 teeth connected?

See below the attachment of the diagram of the tooth. The dentin tubules are in brown and marked.

Bryanna

Originally Posted by kelly123

Thanks so much for the detailed response; much-appreciated! Ironically, I asked about antibiotics after this tooth was RC. The endo said that my infection was nill and hadn't spread into the bone as I had anticipated. NO antibiotics were even given. 6 months prior to the rc, I developed a fistula that I did pop.
I have an appointment with my dentist again in two weeks. One other front tooth is RC and all four are crowns. How bad are partials if I go that route? I am not as concerned about finances as I am aesthetics to be blunt. My dentist does the crown work for the implant. I had one for two molars; very happy with them. THANKS again: you rock!!!

[kelly123]

Bryanna:
You should charge us for the thoughtful and through advice you provide. THANK you from the bottom of my heart. My final(ish) question would be about implants for four front teeth and/or an implant bridge. Could I have the "teeth of my dreams" with this OR do the posts need to be implanted where the roots to the tooth were? I would want to change the size of my teeth if I went through all of this. The two front ones are too wide anyway; hiding a gap. I would make everything much more even for sure. I am 44 and tiny; so my current teeth are too big for my features anyway. THanks.

Originally Posted by Bryanna

Kelly,

Whether or not you had antibiotics at the time of the root canal or not is irrelevant as there will always be bacterial infection inside of the inaccessible hundreds of microscopic canals called dentin tubules. I will attach a diagram for you to see just how loaded the tooth is with those tiny canals. When a dentist says that the rc tooth is not infected, they are referring to an abscess, not to the bacteria that resides in the dentin tubules.

The formation of the fistula indicates the severity of the infection as that is a tract of bacteria that has burrowed a path from the interior of the tooth, into the jaw bone and through the gum. The fistula is just the outlet from the path of infection, similar to the head filled pus on top of a cyst on your skin. The difference in the two is that the bacteria from the tooth is in the bone, whereas a cyst may not be much deeper than the skin.

The infection from root canaled teeth can easily spread to the adjacent teeth. These teeth are also not ideal as anchors for permanent bridge work because they are not healthy and the added pressure of holding a bridge causes them to break down even further. Bridgework that is attached to rc teeth will always be compromised for that reason.


Removable partial dentures take some getting use to. Some people do well with them while others struggle a bit. Dental implants when placed in healthy solid bone can last a lifetime. Dental implants placed in unhealthy bone and/or inadequate bone can be a chronic problem contributing to further bone loss.

You said you have one implant for two molars. Is that a single tooth implant next to a single tooth crown or are those 2 teeth connected?

See below the attachment of the diagram of the tooth. The dentin tubules are in brown and marked.

Bryanna

[Bryanna]

Hi Kelly,

Dental implants are most successful when they are placed in healthy, viable bone. The infectious bacteria and lack of vitality associated with root canaled teeth compromise the health and integrity of the surrounding jaw bone. The longer the root canaled teeth are present, the more widespread the problem can become. Many dentists will place dental implants into compromised jaw bone and hope that any post operative complications are limited and short lived.

The dental implant replaces the root system of the extracted tooth. Sometimes they are put in exactly where the root system was and sometimes not. It depends on the individual case.

Regarding the shape and size of the crowns on the dental implants.... there is some wiggle room but they have to be able to fit properly into your existing arch and occlusion (the way your teeth come together naturally) or they will not be functionally acceptable.

Bryanna

Originally Posted by kelly123

Bryanna:
You should charge us for the thoughtful and through advice you provide. THANK you from the bottom of my heart. My final(ish) question would be about implants for four front teeth and/or an implant bridge. Could I have the "teeth of my dreams" with this OR do the posts need to be implanted where the roots to the tooth were? I would want to change the size of my teeth if I went through all of this. The two front ones are too wide anyway; hiding a gap. I would make everything much more even for sure. I am 44 and tiny; so my current teeth are too big for my features anyway. THanks.