retained root tip
 

I read Bryanna's comments in a previous thread about a possible broken root tip during an extraction, and I was very impressed with her candor and devil's advocate approach. I would appreciate her frank opinion regarding my situation (or anyone else's who wants to play devil's advocate).

In the spring of 2012 I was exploring/invesigating/considering having a tooth implant for #8, which had been chipped severely almost 40 years ago in childhood. I had a cap over it, but the tooth had drifted upward and outward over the years. It needed something done. I was dragging my feet. I knew that an implant would be iffy because there was lots of bone loss over the years.

In May of 2012 I had a severe tooth abscess in tooth #19 that manifested itself on the buccal side of the gums. I'm not sure if it was a periodontal abscess that spread to the tooth or vice versa. I'm not even sure there's any way to tell.

I was in unbearable pain when called an oral surgeon whom I was considering using for the implant. I asked their office for the names of some dentists who collaborated with him with implants. (At that time I didn't even know that oral surgeons dealt with tooth abscesses. I assumed they specialized in higher level stuff.) His office gave me some names, and one of them saw me that day.

The general dentist said he suspected a crack and sent me to an endodontist, who almost immediately diagnosed the tooth with a severe fracture of the roots and crown. The endodontist said I'd be wasting my time with a root canal and that the tooth would have to be pulled. He didn't really explain his reasoning, but I thought that it must be legit for an endodontist to take away business from himself to give it to others. I was in a hurry to have it dealt with ASAP.

The endodontist said the oral surgeon needed to pull the tooth. I called the oral surgeon's office that same day, and they said they were busy for awhile. I can't swear to it, but I believe they advised me to go back to the general dentist because that's what I did. I can't imagine doing so on my own, after the endodontist told me I needed the oral surgeon to pull it.

The general dentist pulled the tooth unremarkably (i.e., without a flap, without sectioning). Based on my memory, it must have been a straight forceps extraction. During the extraction he broke off and left a root tip in my jaw, presumably highly infected. He didn't bother to tell me about it.

I didn't know what he had done, but I was dissatisfied with the him for his general vagueness. So when I believed I had a lingering infection a week later, I called another dentist to check it out. After the second dentist took a panorex, he sent me home, postponing a scheduled teeth-cleaning for that day until my mouth cleared up. The root tip is faintly visible in his panorex, but I didn't notice it, and this second dentist didn't tell me about it either.

Symptoms of swelling and then drainage (starting in June) persisted in the buccal side of the gums throughout the summer. I eventually discovered the root tip from a CT scan done four months after the tooth had been pulled. Another oral surgeon took it out in September 2012.

I can't understand is why I wasn't told about the broken root tip. I've seen veterinary guidelines, and dogs are supposed to be treated better than I was (i.e., the dog's veterinary dentist is supposed to inform the owner about a retained root tip).

Although I seem to be fine now, I have some lingering questions that I'd appreciate some devil's advocates to take a stab at.

1. Why would a dentist leave a highly infected root tip in my jaw without my knowledge? What are some possible reasons? Why didn't he take it out?

2. Besides the hidden root tip, what else seems wrong with this scenario? In other words, what actions or treatment issues strike you as suspicious? What do you think was going on?

Thank you for reading this. I would have posted the endodontist xray and the panorex, but I apparently can't attach images until I've had 10 posts.

Hi parminides,

Me candor?? You've got that right ;) Hard to be the devil's advocate when you know right from wrong.... but it is not up to me to tell people what they should and shouldn't do. I'm just here to plop down the information :)

I will re-post your questions and answer in bold type.

<<1. Why would a dentist leave a highly infected root tip in my jaw without my knowledge? What are some possible reasons? Why didn't he take it out??>>

BECAUSE HE WAS AFRAID TO GO AFTER IT! THAT IS WHY IT IS IMPORTANT TO HAVE AN ORAL SURGEON REMOVE TEETH, ESPECIALLY IF THEY ARE INFECTED. IF THEY BREAK OFF A ROOT TIP THEY GENERALLY WILL RETRIEVE IT. THERE ARE TIMES THAT IT IS BEST TO FLAP THE ORAL TISSUE, EXPOSE THE BONE, SECTION THE TOOTH AND GENTLY ELEVATE THE TOOTH FROM THE BONE. YOUR CASE MAY HAVE BEEN ONE OF THOSE TIMES. HE KNEW HIS APPROACH TO THE EXTRACTION WAS NOT FAVORABLE WHEN HE REMOVED THE TOOTH AND SAW THE ROOT WAS BROKEN OFF. I'M SURE HIS HEART SANK. BUT EVIDENTLY NOT ENOUGH TO INFORM YOU!
SOME DENTISTS ARE NOT THAT CONCERNED ABOUT RETAINED ROOT TIPS UNTIL THE PATIENT SWELLS UP OR WORSE. IRRELEVANT OF THAT, 99% OF THE TIME IT IS NOT IDEAL TO LEAVE A ROOT TIP IN THE JAW BONE.

<<2. Besides the hidden root tip, what else seems wrong with this scenario? In other words, what actions or treatment issues strike you as suspicious? What do you think was going on?>>

I THINK I ANSWERED THIS IN MY ABOVE STATEMENT.
REGARDING THE FACT THAT NEITHER HIM NOR THE SECOND DENTIST INFORMED YOU ABOUT IT...... EITHER THEY ARE NOT TOO GOOD AT READING XRAYS AND/OR THEY CHOSE TO IGNORE IT FIGURING YOU WOULD EVENTUALLY END UP ELSEWHERE. NEITHER OF THOSE EXCUSES IS ACCEPTABLE IN MY OPINION.

I am glad that you had it removed and that the area seems to be doing well!!

What are you doing about tooth #8?

Bryanna

Thank you for your quick reply.

As for #8, I'll probably get a denture! One reason is the pre-existing bone loss makes it a very questionable candidate for an implant. I don't want to spend all that money if there's very little chance of success.

I wish that I could have attached the xray from the endodontist and the panorex from the second dentist. I would love to see what you think. But I'm brand new to this forum, and I apparently must have 10 posts before I can attach files or put links in my message. (Only 8 more to go after this one!)

You might not want to spend much time on my case since it seems resolved. I can understand that. You seem to be on the forum to help people. When I said I was fine, it's not quite so simple. I meant that all the infection seems to be out of the bone. But I'm still draining slightly from the buccal gums, almost a year and a half after the extraction.

For many months I would have bet a lot of money that I had osteomyelitis. Not anymore. I had my teeth cleaned in August, and an xray showed that the root channels had completetly filled in. That image convinced me that this remant drainage must be confined to the gums. So that's the long version of "I seem to be fine now."

I think I have a small, chronic, periodontal abscess. The place that cleaned my teeth in August didn't get the full history, because I've found that no one wants to jump into someone else's medical error, followed by unending complications.

The dentist I saw in August said that this kind of thing could take years to resolve or might never go away. He didn't call it a periodontal abscess or anything. He said he could do a gingival curettage or an open flap debridement that might help.

I was reluctant to go through with either procedure since he might have recommended something completely different if he'd known about the root tip. All he knew was that the tooth had been pulled almost a year and a half ago, and I still have drainage.

You don't know the full history either, but you know about the root tip that lurked in my jaw for four months. Something else that might be pertinent is that I've been on antibiotics five different times since the tooth was pulled. Three times before the root tip was removed and two times afterward (the last course was in January).

Do you think a gingival curettage and/or an open flap debridement would be the best thing to try to finally knock out the lingering drainage? If not, what would you recommend?

Parminindes,

I think you definitely have something going on there. Whether it is bone and/or tissue related... that is hard to tell. It is a good sign that the bone appears to have filled in since the removal of the tooth. However, dental xrays are only 2 dimensional so if the film were angled differently the area may or may not take on the same radio-graphic appearance.

I would not opt for an open flap procedure there as that could compromise the integrity of the oral tissue and cause severe gum line recession. What you might look into is a laser procedure called LANAP. This requires no cutting of the tissue with a scalpel so there is no trauma to the oral tissue. The laser is used in the sulcus between the tooth and the gum. It is so precise as it kills the bad bacteria and restores the health of the good tissue.

Do you have periodontal disease? Have you consulted with a periodontist about this area or others? Have you had any form of periodontal treatment?
You mentioned getting a denture to replace tooth #8. Are you missing other teeth in your maxillary arch that you are hoping to replace with this denture?

I would like to see those xrays so keep posting ;))

Bryanna

I'm surprised and concerned that you think it might be bone related. I thought that the bone filling back in would be the opposite of what an infection would do (eat away bone). What's wrong with that line of thinking?

I do have periodontal disease. I have avoided seeking treatment because if what's leaking out of the side of the extraction site is some antibiotic-resistant infection, I don't want to introduce it into all those deep cracks. That may not be a valid reason, but that's why I've put off treating the periodontal disease. I want to take care of this leaky jaw problem first.

I have seen one periodontist and some oral surgeons. The sad truth is that no one wants to inherit my jaw. I know it's a major breach of ethics to leave a root tip in a patient's jaw without telling him. I've never seen a single source that says it's acceptable to leave an infected root tip in a patient. Also, the root tip was near the surface (maybe because he tried to get it out?), another reason *never* to leave it in.

No one wants to take over that mess. The leakage is at such a low level that they don't see it. Nor is there a well-defined fistula (at least that they admit to seeing). So doctors and dentists generally just say that they don't see what I'm talking about.

This dentist last August was an exception, but I didn't tell him about the root tip! I told him about others doubting my symptoms. He said that he never doubts a patient when they say they're draining.

I'm not missing any other teeth in the maxillary arch. I know I could get a bridge, and maybe I will. But the idea of messing up two more teeth isn't very appealing to me. I know it would be a lot less trouble for me in the long run.

Only 7 more posts to go!

Parminides,

I gathered that you had untreated periodontal disease. The problem lies in the bacteria that causes this disease. It is highly infectious and aggressive. It is rarely, if ever just contained to one area of the mouth.

You wrote:
<<I do have periodontal disease. I have avoided seeking treatment because if what's leaking out of the side of the extraction site is some antibiotic-resistant infection, I don't want to introduce it into all those deep cracks. That may not be a valid reason, but that's why I've put off treating the periodontal disease. I want to take care of this leaky jaw problem first.>>

My answer: The ongoing problem that you have with that particular area is not going to heal due to the overall bacteria in your mouth from the perio disease. That is why I suggested that you look into the LANAP laser therapy as it can beneficial with not just that area but your entire mouth.

The root tip was probably near the surface because it had worked it's way up from where it originally was. That can happen... not all that unusual.

Before you have #8 removed... please seek a consultation from a periodontist who uses the LANAP laser. Have an overall examination and treatment plan. I have no doubt that #8 needs to be removed but your replacement options may be different than you assume. If you have other teeth in your maxillary arch that are very ill from periodontal disease, you may not want to hold onto them. So a removable partial denture could be made to replace those teeth as well as #8.

Bryanna

Thanks again for all your attention. I really appreciate it. I'll keep this one shorter so I can get to 10 posts sooner!

In you last message you didn't address my argument that the bone isn't infected or else I would have undergone more bone loss instead of bone gain (filling in the root channels). I know it would be much better if you could see the xrays, but what do you think of my argument in principle?

I had a flare up in September 2012 and various infections seemed to florish together (probably by weakening my immune system). I wanted all infection sources removed, so #8 was pulled at that time (it was known to be infected).

The first panorex that showed the root tip at the top was taken a week after the extraction. It doesn't seem possible that it could work it's way from the bottom to the top in only a week. Can that happen?

I don't think my periodontal disease is as advanced as you make it sound. My teeth are not loose.

Parminides,

As I said, dental x-rays are 2 dimensional and depending on the angle of the film the area of #19 may show differently at a different angle. I hope that it has healed but because you have a chronic infection there, it cannot be assumed that the bone is healthy because it appears to have filled in on one x-ray.

Even if the bone has healed well from the extraction, if there is a perio infection ... the bone will deteriorate from that bacteria which may or may not show up on a dental x-ray until the bone loss is severe.

<<The first panorex that showed the root tip at the top was taken a week after the extraction. It doesn't seem possible that it could work it's way from the bottom to the top in only a week. Can that happen?>>>

Maybe it wasn't a root tip. Maybe it was a piece of splintered bone. They both resemble each other.

I have no idea how advanced your periodontal disease is. You mentioned that you have had it but never had it treated. So I assume you have had it for awhile. This disease does not get better on it's own. In the early stage it can be remedied with daily diligent oral hygiene care at home. Oil pulling with coconut oil can also be very helpful. But once the bacteria has advanced it is difficult for the patient to remove it.

Some people with perio disease do not have loose teeth while others do. Some people have gum tissue recession while others have deep pockets.

Bryanna

Thank you for giving some more detail about how a single xray can't prove there's no infection.

It was definitely a root tip. I saw it after it was removed. It had a curved shaft that came to a smooth, rounded point, just like the root appeared in the xray before the tooth was pulled. No one familiar with my case has suggested that it wasn't a root tip.

The reason I think my periodontal disease is not that advanced is that none of the doctors have made it sound very dire. What is "oil pulling with coconut oil"?

parminides, I see you continuously referencing the 10 post rules for links, but that does not apply to photo attachments. You are allowed to use our attachment feature for a photograph....you will see "manage attachments" in the section below the box where you type your post.
Just to be sure to remove all personally identifying info from your xrays etc before you attach them to your post

There is a paperclip icon above the text box, which opens a window called "Manage Attachments." That's how I tried to attach a couple of xrays on my first post (unsuccessfully). It seems to do the same thing as what you described.

I tried it again. In case it works, Bryanna, the first image is an xray the endodontist took before the tooth was extracted. The tooth on the left is number 19. The second image is the panorex taken a week later, and the third image is the dental xray taken in August showing the root channels filled in.

Thanks to Chemar, I was able to finally post some images.

Bryanna, would you mind taking a look at them (see previous message) and rereading my first post? I would love to learn what you think.

Besides the root tip, do you see anything worrisome in the panorex, especially around the extraction site, but really anywhere in the image?

Do you see any evidence of a root or crown fracture in the first xray image, which was taken the day before the extraction? Do you see anything worrisome in that image?

Comparing the panorex to the last image, which was taken last August, almost a year after the root tip was removed, do you think it's likely that the jawbone is clear of infection?

Hi Parminides,

Thanks for posting the x-rays!!
Sorry for the delay.... I work varied hours throughout the week so I am not able to be here all of the time. A big thank you to Chemar for guiding you through the attachment process ;)

I will re post your questions and answer in bold type.

<<<Besides the root tip, do you see anything worrisome in the panorex, especially around the extraction site, but really anywhere in the image?>>

THE ROOT TIP WAS NOT ACTUALLY AT THE SURFACE. IT WAS CAUGHT IN HIGH UP IN THE OPEN CHANNEL WHERE THE MESIAL ROOT USE TO BE. I'M GLAD IT WAS REMOVED.
I CAN SEE THAT YOU HAVE GENERALIZED BONE LOSS THROUGHOUT YOUR DENTITION. YOU HAVE SOME OVERCROWDING/CROOKED TEETH IN THE FRONT LOWER ARCH WHICH CAUSES AN OVERLAPPING OF TEETH ON THE X-RAY MAKING IT DIFFICULT OF DISTINGUISH ONE TOOTH FROM ANOTHER. HOWEVER IT DOES LOOK LIKE YOU HAVE MODERATE BONE LOSS ASSOCIATED WITH SEVERAL OF THOSE TEETH.
YOU ALSO HAVE SOMETHING IN THE LOWER RIGHT BONE BEHIND YOUR SECOND MOLAR. LOOKS LIKE A SMALL WISDOM TOOTH THAT NEVER FORMED COMPLETELY OR A REMNANT OF A WISDOM TOOTH. HAS ANYONE MENTIONED THAT AREA TO YOU?
THE UPPER FRONT AREA HAS A LOT OF SHADOWING IN PART DUE TO SOME OVERLAPPING/CROWDING OF TEETH THERE ALSO. SO IT IS DIFFICULT TO SEE THE ANATOMY CLEARLY. HOWEVER, TOOTH #7 ...AND POSSIBLY #9 MAY HAVE SOME HEALTH ISSUES DUE TO THE SPREAD OF INFECTION FROM TOOTH #8. IT WOULD BE WISE TO HAVE A FEW PERIAPICAL X-RAYS OF THE UPPER FRONT OF YOUR MOUTH TO SEE THE BONE MORE CLEARLY. HAS ANYONE MENTIONED ANYTHING ABOUT #7 AND 9?

<<Do you see any evidence of a root or crown fracture in the first xray image, which was taken the day before the extraction? Do you see anything worrisome in that image?>>

IT APPEARS TO ME THAT THE MESIAL ROOT (ROOT TO THE LEFT OF BOTH ROOTS) WAS FRACTURED FROM THE CROWN DOWN TO THE ROOT. THERE WAS DEFINITIVE PATHOLOGY IN THE BONE SURROUNDING THE MESIAL ROOT MOVING OVER TO THE DISTAL ROOT. SO IT WAS WISE TO HAVE THAT TOOTH REMOVED.

<<<Comparing the panorex to the last image, which was taken last August, almost a year after the root tip was removed, do you think it's likely that the jawbone is clear of infection?>>>

THE MAJORITY OF THE HEALED EXTRACTION SITE HAS FILLED IN AND LOOKS PRETTY GOOD IN THE LATEST X-RAY. HOWEVER, THERE IS A SMALL DARK AREA SHAPED LIKED A HALF MOON JUST BELOW THE GUM ON THE MESIAL (LEFT) SIDE OF THE EXTRACTION SITE. I WONDER IF THIS IS A RESIDUAL POCKET OF BACTERIA??? YOU SAID YOU WERE STILL GETTING SOME DRAINAGE ON THE BUCCAL AND THAT MIGHT EXPLAIN IT.

Bryanna

Bryanna, thank you for looking at the images.

Yes, other people have mentioned the wisdom tooth remnant, which has been interpreted as another root tip (although it looks too wide to me).

Other people have also mentioned that the bone loss associated with #8 has spread and will potentially affect other teeth. When I had #8 pulled in September 2012, they added a bone graft or some kind of filler. Other than that procedure, I've put #8 and its neighbors on the back burner until I have a handle on this leaky #19 extraction site.

You said that you think #19 had a crown to root fracture. Would you look at the attached image? Does the yellow line I added correspond to what you think might be the fracture?

You also mentioned a slightly darkened area just below the gumline on the most recent xray (from last August). That was a very interesting observation. I wonder if you're not on to something there!

There are three things on the panorex I'd like to ask you about. Do you see the dark area under the molar roots on the right side of my mouth (left side of the image)? Notice how much darker it is compared to the same area on the left side. Does that mean anything to you? Is it something to worry about? (It's not an artifact unique to this image. The right side is darker in all the panorexes I've had.)

Do you see how the root channels from the extraction site appear to actually enter the mandibular canal? (This is not an optical illusion. It is evident from the slices of the CT scans.) Why didn't the infection from the original dental abscess go into the canal and travel somewhere else, such as the neck? Do you think that the dentist who extracted #19 would have seen that the channels entered the canal visually after he pulled the tooth, or would everything have been too bloody? What are the possible complications of infected roots impinging on the nerve canal?

Lastly, do you think the panorex indicates that the roots in my upper arch teeth go into my sinuses? I seem to have been blessed (or cursed) with particularly long roots.

Sorry to ask so many questions, but you've finally seen the pictures!

Parminides,

Do you recall if your lower right wisdom tooth was extracted and that is what was left behind? It looks like the crown portion (the top) of a wisdom tooth that is remaining in the bone.

Yea, I am concerned about the spread of bacteria and bone loss associated with tooth #8. I know you want to put that area on a back burner but that might not be such a wise thing to do. According to ancient chinese medicine, that area of the mouth is connected to the urinary and renal collecting system. Which means the bacteria from that area will likely travel to those other systems. I can tell you from my professional experience that I know of patients who had infections in the upper anterior teeth who also had bladder, prostate and/or renal problems.

The yellow line that you drew (nicely articulated by the way) could be where the fracture was or that could be your normal anatomy. I see a possibility more towards the center of the tooth, just left of the center that starts at the crown of the tooth and travels down through the pulp chamber into the distal portion (near the back) of the mesial root (first root). Did the dentist show you where the crack was? Do you know how you cracked that tooth?

Yea, there is a small void in the bone just below the gum line where tooth #19 was. Frequently a dentist will not pick up on this :(

The darkened areas on the panorex pertaining to your lower right side may be indicative of an infection. A periapical xray may be helpful in determining that. If it is, I would tend to think it could be linked to that odd wisdom tooth in that quadrant. You said that area has looked dark on other panorex films. Has the darkened area gotten larger? Is there any drainage or pain in that area? What have your dentists said about it? How did that area show up on your CT scan? If it has not been evaluated by an oral surgeon, I think it should be.

I'm not positive if the roots of your lower molars go directly into the mandibular canal. Keep in mind these are only 2 dimensional xrays. The CT scan may have showed something different as you said.

Regarding the travel of bacteria from an infected tooth to another area of the body... it depends on what area of the body shares the same meridian path with that tooth. Here is a chart that shows those paths....
http://toothbody.com/wp-content/uplo...v2.1_rehme.swf

The dentist who extracted #19 may have been able to tell if he was in the mandibular canal because that area feels different than bone when you touch it with an instrument the texture of the blood may be different also. But typically general dentists do not really look for these signs.

There are a variety of possible complications regarding infection and the mandibular canal. Each case would be different. Some people may have temporary or permanent numbness, others may have radiating nerve pain, some could have temporary or permanent facial paralysis, others may end up with further infection.

I think you definitely have long roots!!! It is very possible that the posterior teeth are either in or in close proximity to your sinuses. The pan is just a 2 dimensional xray.... so it can be deceiving when trying to view it from that perspective.

Bryanna






(

Thank you so much for your detailed reply.

I remember that all four wisdom teeth were pulled at one time, and that the dentist had a lot of trouble with one. This was about twenty years ago, and I don't remember if he told me that he left a piece. But I haven't had any trouble from there.

I'm attaching an xray from last August of the #8 area of my mouth. See what you think about it.

I think I see what you suspect might be a crack in #19. It was an endodontist who said the tooth was cracked (after a general dentist said he suspected a crack). The endodontist did not show me on the xray. I was in pain and ready for some relief and wasn't too skeptical or interested in challenging him. If it was cracked, I have no idea how I got it.

I don't think the dark area on the right side of my mandible has gotten larger, although it's hard to say for sure since every x-ray has its own artifacts, etc. In September 2012, with the root tip still inside, the extraction site of #19 burst like a blister and drained completely. The swelling was gone and the area felt normal for the first time since the tooth had been pulled.

For a brief period it wasn't draining. During that period I noticed drainage coming from the dark area on the right side (which I've dubbed the mandibular swamp!). Apparently that drainagae source had been "drowned out" by the #19 drainage before then.

The general consensus is that the mandibular swamp is just a normal variation between my right side and left side. That seems strange to me, but that's what I've heard over and over. The way some people put it is that my nerve canal is wider on that side. It's very evident in the CT scans was well. It's like a cave on the right side.

One oral surgeon said the drainage I once perceived in that area might be discharge from a deep periodontal pocket. That same oral surgeon later said it might be a tumor or neoplasm and wanted to do a deep bone biopsy. I never let him do it because I lost confidence in that guy, who was really the only one who's seen me who ever thought that dark area might be bad.

Are you starting to understand that my mouth is a riddle wrapped in a mystery, surrounded by an enigma?

The track on the image of #19 pre-extraction (that I outlined in yellow) has bugged me to no end. Notice that there's overlapping bone to the left of it but none to the right. It just doesn't make any sense to me at all. Dentists have tried to explain to me that it's the angle of the camera, it's 3-D compressed to 2-D, etc. But no explanation convinces me that the overlapping bone should just abruptly stop like that.

When I was asking about the spread of infection, I just meant by the simple pathway of infection in #19 root channels spreading to mandibular canal and then traveling along the canal into the neck, just because there's a clear pathway. I've wondered why the infection didn't do that.

Parminides,

I cannot enlarge this xray but it does look like tooth #9 and 10 have problems. It looks like there is an infection in the bone around both of those teeth. Tooth #7 is not on this x-ray. The root of #9 appears to be disintegrating. Surely you have been informed about these teeth by at least one of the dentists you have seen??

Yea, that piece of wisdom tooth on the lower right is not in a good place. If you had drainage on that side then that would indicate an infection and that could be why that area is so dark on the xray. I think this needs further evaluation as well as the upper front.

Bacteria from an abscessed tooth does not have to follow any particular pathway especially if it is draining out through the gum. So that could be why the infection from #19 didn't end up in your lymph nodes under your neck on that side.

Bryanna

Thanks for continuing to answer my questions. I really appreciate it.

I provided a side-by-side comparison of 3 xrays showing #8. The leftmost one was taken in May 2012, about a week after #19 had been pulled. (What in the world are those two dark, slanted lines at the top that seem to outline a small-scale version of Mt. Everest in my mouth?) The middle xray is from Aug 2012 and the last one is from Aug 2013.

After comparing them side-by-side myself for the first time this morning, I'm disappointed that there seems to be little if any bone regeneration since #8 was yanked.

I knew that the bone loss around #8 had endangered the adjacent teeth, but no one made it sound as dire as you do. The first oral surgeon thought an implant was possible if I had bone and soft tissue grafting when #8 was pulled, and possibly secondary grafting before the implant.

Another oral surgeon pulled #8 in Sep 2012. His records state that "Foundation graft placed 4-0 chromic gut." I'm almost certain that he didn't do a soft tissue graft.

What do you think needs to be done about the #8 vicinity after learning some more history and seeing a couple of more xrays?

Parminides,

Thanks again for posting the xrays.

The two dark "Mt Everest" lines are an artifact indicating the film may have been bent during the exposure. It is not your anatomy :)

Yea, I think there is something brewing in the upper front quadrant of your mouth. Tooth #9 appears to have a cavity on the distal portion of the root surface. The root of this tooth is also misshapen indicating bacteria and/or lack of vitality.

The lack of bone regeneration is caused by the chronic bacteria that is still residing in the bone not just from the previously abscessed #8 but from your periodontal disease as well. In addition to that the adjacent teeth do not appear to be healthy which is also preventing the #8 site from heal properly.

The more xrays you post here the more obvious it becomes that your periodontal disease is not under control. I don't mean to sound so "dire"... I am just telling you as I see it. I am puzzled as to why a dentist has not informed you of the things that I have.... especially since it seems that you have seen various dentists. Or have you been informed and perhaps don't believe it or it scares you or......??

I can see without a doubt that tooth #8 was infected for quite some time. Whether you had symptoms or not, a tooth does not become that abscessed unless it has been brewing for possibly a few years or more.

If I had to prioritize I would say that your biggest dental problem is your periodontal disease..... second the infected teeth that you may have which need a clear diagnosis ...and third the generalized bone loss. The xrays indicate you have deep pocketing and/or various areas of gum recession.

What are your thoughts about the periodontal disease?

Also you asked me awhile back about oil pulling....
This is an ancient therapeutic method used to keep healthy gums healthy. It can also be beneficial in those with periodontal disease but cannot take the place of proper periodontal therapy or professional cleanings.
A simple version of this is.... place one tablespoon of melted coconut oil in your mouth and move it around coating your entire mouth, teeth and gums. Do this for at least 1-2 minutes or longer. Then spit it out. You can brush afterwards.

Bryanna