Hi JR,
I will re post some of your thread and answer in bold type.
<<The saga continues...I had a 3D CBCT done (a limited FOV, #18 and #19 area as I wanted to limit the exposure) and had it read by a board certified oral radiologist (independent from the owner of the scanner). The fellow has read thousands of scans.>>
WAS TOOTH #20 CAPTURED IN THAT SCAN? IF NOT, WHY NOT? YOU WERE HAVING SYMPTOMS WITH THAT TOOTH IF I RECALL CORRECTLY. ALSO TOOTH #18 IS ROOT CANALED CORRECT?
>>>>Correct, 18 was RTC. Only #18 and #19 were captured. The FOV was limited to two teeth (strange), else they would have had to do a much larger scan.
FYI ... IF THE ORAL RADIOLOGIST IS OF THE OLD SCHOOL THOUGHT THAT ROOT CANALED TEETH ARE A BENIGN MATTER THEN HE IS NOT LOOKING AT THE WHOLE PICTURE. IF THAT IS THE CASE, THEN UNLESS THERE WAS A LARGE BLARING BONE INFECTION, HE WOULD SEE NO CONCERN WITH RC #18.
>>>The radiologist noted some issue with 18 but he could not determine if tooth #18 has a residual lesion of endodontic origin. Slices are blurred a bit.
<<Interesting findings that I have discussed with my OS. 1. A foreign body visibile on the coronal slice, adjacent to the implant screw on the buccal side 2/3 down towards the apex (indeed, a piece of amalgam was visible on the post extraction x-ray back in June 2015 -- it was apparently strongly embedded in the bone; a leftover from the apico in 1991..When I had brought this up with the original periodontist he was not concerned...)>>
DID THE OS CONFIRM THAT THE MERCURY WAS STRONGLY EMBEDDED IN THE BONE? DID HE GIVE YOU A REASON FOR NOT REMOVING IT WHEN THE PRIORR TO PLACING THE IMPLANT?
>>>Frankly, I do not think he had seen it when placing the implant crew.
THE MERCURY IS A TWO FOLD PROBLEM. NUMBER ONE IT IS A TOXIC METAL THAT GIVES OFF A GALVANIC RESPONSE WHEN IN CLOSE PROXIMITY TO ANOTHER OR A DISSIMILAR METAL. KEEP IN MIND THAT THERE ARE BUNDLES OF NERVES IN THIS VERY SAME AREA THAT COULD BE GETTING ZAPPED BETWEEN THE 2 METALS. I'LL BET NO ONE HAS ADDRESSED THAT ISSUE WITH YOU.... ? THE OTHER PROBLEM IS THAT THE MERCURY IS CONTAMINATED WITH BACTERIA FROM THE INFECTION THAT WAS PROLIFERATING FROM TOOTH #19 IN SPITE OF THE ROOT CANAL AND THE APICOECTOMY. SO IT IS NOT A BENIGN PIECE OF NOTHING.
>>>I agree.
THE PERIODONTISTS DIS-CONCERN TO THE MERCURY BEING PRESENT WAS ... NOT SURPRISING COMING FROM A CONVENTIONAL DENTIST. HE HAS YET TO CATCH UP WITH THE ABUNDANT INFORMATION CONFIRMING THE DANGERS OF RETAINING MERCURY IN THE MOUTH OR ANYPLACE IN THE BODY. BUT OF COURSE, HIS DIS-CONCERN LED YOU TO BELIEVE THAT ALL WAS WELL.
<<Some luncency around the apex of the screw that the radiologist suspects to be peri-implantitis. Unclear if there some lesion in the RT canalled #19 (perhaps I moved during the scan as the image is not very clear on sagittal or coronal views).>>
IT IS NOT ABNORMAL TO HAVE SOME LUCENCY AROUND THE APEX OF A DENTAL IMPLANT. THIS COULD BE DUE TO INFLAMMATION SUCH AS PERI-IMPLANTITIS, OR IT COULD BE THAT THE ORAL SURGEON INITIALLY DRILLED FURTHER INTO THE BONE THAN THE ACTUAL LENGTH OF THE DENTAL IMPLANT. SO THAT WOULD BE A VOID IN THE BONE AT THE APEX OF THE IMPLANT. IN EITHER CASE, SOMETIMES IT'S A PROBLEM AND OTHER TIMES IT'S NOT.
RC TOOTH #18 IS A PROBLEM IRRELEVANT OF WHETHER OR NOT THERE IS A BLARING LESION OR BONE INFECTION. PLEASE VIEW THE DIAGRAM OF THE ANATOMY OF A TOOTH ... ALL OF THOSE DENTIN TUBULES, OF WHICH THERE ARE MANY MANY HUNDREDS, CONTAIN INFECTED NECROTIC NERVE TISSUE. BY THE TIME THE INFECTION BECOMES PROLIFERATED ENOUGH TO SEE ON AN XRAY OR SCAN, THE BACTERIA HAS ALREADY GONE BEYOND THE TOOTH.
<<I have had a good, long discussion with my OS who is really an experienced guy and whom I trust. Clinically he sees no problems at all with the implant and has no clinical reason to remove it. He routinelly overdrill a bit so that he does not compress the bone and has a bit of a wiggle room. Thus, the shadow in his opinion, around the apex.>>
OKAY SO THEN HE DID OVER DRILL THE LENGTH OF THE IMPLANT. WHICH COULD ACCOUNT FOR THE APICAL LUCENCY. HOWEVER, THAT DOES NOT ADDRESS THE MERCURY OR THE INFECTED #18 ISSUES.
>>>Correct.
<<So where do we go from here...? (Of course the OS could remove the implant but what guarantee do we have that the pain will subside?). Should we focus on the #18 and perhaps take it out...? A serious conversation with an endodontist? Thanks again for your thoughts! >>
A DENTAL COLLEAGUE OF MINE RECENTLY EXPLAINED TO A GROUP OF PEERS HOW ENDODONTICS IS THE BREAD AND BUTTER OF DENTISTRY. I THOUGHT THAT STATEMENT SAID A MOUTHFUL!
>>>Maybe general dentistry is bread, but endo is the butter
THE ENDODONTIST IS GOING TO RECOMMEND ANOTHER ROOT CANAL OR AN APICO ON #18. WHICH WOULD PUT YOU IN THE SAME POSITION AS WITH TOOTH #19. ONLY WORSE BECAUSE YOU ARE ALREADY HAVING ISSUES ASSOCIATED WITH THE REPLACEMENT OF #19 REGARDING WHAT WAS LEFT BEHIND FROM THAT TOOTH INFECTION AS WELL AS WHAT WAS LEFT BEHIND FROM THE EXTRACTION OF THAT TOOTH.
>>>No way, am I doing an apico. That's a barbaric procedure. Retreatment would not be a viable option, either.
THE REMOVAL OF #18 IS INEVITABLE. THE COMPLICATIONS FALL UPON THE FACT THAT #18 WAS STILL PRESENT WHEN #19 WAS REPLACED WITH AN IMPLANT ... THE MERCURY PLUG FROM THE APICO ON #19 IS STILL PRESENT ... AND NO ONE IS MENTIONING THE SPREAD OF BACTERIA FROM 19 TO 18 AND NOW POSSIBLY 20.
The issues you are having would be very clear to someone who appreciates the vast problems arising from the issues I have mentioned. However, it is unlikely that any of your conventional dentists are going to put all the pieces of this puzzle together. Instead they are going to treat one symptom at a time without looking at the picture in it's entirety.
By any chance have you gotten the book that I recommended to you? The author Dr Kulacz talks about all of this and explains it in terms that you would especially appreciate given your intellectual knowledge.
05-17-2016, 06:13 PM
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