To implant or not to implant (dental)

[dub]

I have a question for you guys, and I apologize if this is the wrong sub-forum.

Some background:

• About 12 years ago, I had a root canal on an upper molar all the way in the back of my mouth.
• About 7 years ago I started experiencing pain a few times a year in that tooth. I was told by my (then) dentist that it was impossible for me to feel pain in that tooth and it was probably my sinuses. He gave me an antibiotic prescription and sent me home. The drugs did no good. Oh yeah, and the receptionist was a bee-otch. I never went to that dentist again.
• About a year ago the pain was much worse and progressed to the point that I couldn't eat on that side of my mouth. New dentist took an x-ray and saw an abscess. Medication was prescribed.
• Following treatment, the pain persisted. He recommended either removing the tooth or going for a second root canal in case the previous root canal wasn't thorough. At my age, I opted to try and save what's left of my tooth and go for the second root canal.
• It's been about 2 - 3 months since the second root canal and I'm still experiencing the same pain. No improvement.

So here's my current dilemma:

The dentist says I likely have a cracked tooth. In which case, there's nothing more he can do to save the tooth. So at this point I can either:

(A) Have the tooth yanked for $40 (after insurance) and be done with it. Pros - I won't have to worry about the tooth anymore. Cons - some degree of bone loss in jaw bone is pretty much guaranteed, which can lead to problems with sinuses, premature aging among other issues. The missing bone can also cause the tooth below to "super erupt" out of the gum, which would then need to be removed. It can also cause the other teeth in the row to drift over time and jack up my smile. Or, none of those things can happen.

(B) After having the tooth removed, I can get a bone graft and a partial or an implant. Pros - I won't have to worry about super eruption, tooth drift or additional jaw bone loss. The success rate is pretty high. Cons - It's expensive. There is the potential for infection. There is the potential for the implant to be rejected. It's expensive.

So my question is -- have any of you guys gone through either scenario? Which do you recommend? Any problems I'm overlooking? Am I over-thinking it? Thoughts?

 

[Relayer1]

Over thinking it.

I had a deformed wisdom tooth that gave me absolute hell.I tried to keep it for years, even when it cracked.

Eventually I had it pulled. I went straight to work from the dentists and have had no trouble and no regrets since.

Do what you feel is best, but don't keep worrying about it.

 

[dub]

I've had all of my wisdom teeth pulled. This is one of the next teeth over from the wisdom teeth.

But yeah, I have a feeling I'm over-thinking and worrying. The internet is a blessing and a curse!

 

[propita]

I'm not the only one here who's had abundant dentist experiences.

A few fillings I don't even think about and no idea where they are.

Three wisdom teeth (not four). All pulled, no problem.

All eight molars have/had gold crowns. Fifteen crowns, in fact, because I kept destroying them. Annoying and costly, but no problems. Some of the teeth just fell apart under night-grinding or cracked chunks off. Yeah. It's as wonderful as it sounds.

Three molars root canal-ed. No problems aside from discomfort.

One of those root canal-ed molars cracked. Actually, it had two cracks and a hole in the side. I had it yanked and got an implant. It was a six month process, a bit painful, and I didn't like drilling into my jaw (my whole head vibrated--quite disconcerting). I hated having sutures in my mouth; the threads would pull when I swallowed, giving little "ouches" often. And it wasn't cheap. But it was worth it so my teeth would stay in place.

Strangely, my dentist says my teeth are actually good.

If you can afford it, get the implant. Your teeth won't swim around in your jaws.

 

[rhubarbodendron]

got 3 dental implants but in the lower jaw. My dentist suggested one in the upper jaw to replace a broken tooth. I consider that too risky as the upper jaw has a thinner bone and the implant would protrude into the sinuses. Normally that'd be no prob but I have lip herpes that spread to the gums and the last place I want it to break out is in cavities that have an immediate connection to the brain. Hence I am opting for a bridge.

In your case, I'd

first of all: go to another dentist (or even better: a dental clinic) and get a second opinion. A crack should be visible on an x-ray. Some dentists already have these new ultrasonic sensor thingies that give you actually a much more detailed image of a tooth than an x-ray can. I very much doubt the tooth is cracked for in that case it'd gradually come loose and it's still solid in place (I presume, from what you posted).

A molar in a position past tooth #5 has several roots (usually 3, often even 4). So if you have one root canal filling there'd still be 2-3 roots left to get caries and hurt. This is another reason why I suspect your dentist is not very good at his job (putting it mildly).

An abscess should first of all be treated by opening the root canal and draining the abscess like that. (Provided, it is at the tip of that respective root).

If that's impossible, usually the bone is cut open over the abscess, the abscess removed and the tip of the infcted root as well. This is called an apicoectomy (literally: a cutting off of the tip) http://en.wikipedia.org/wiki/Apicoectomy
In both cases you'd get a treatment with antibiotics in addition.

Only if all this fails, the tooth should be extracted.

I recommend you get this second opinion and treatment really soon because the longer you wait, the more of the bone gets destroyed by the abscess and then the tooth really can't be rescued anymore. It might even affect the neighbouring teeth.

As an alternative to the implant you could also have a free-end-bridge. That would require the 2 teeth standing before the infected end-tooth to be grated down to stumps. It's worth the effort only if these teeth need crowns anyway. However, if they have big fillings you could use inlays as anchors for the free-hanging last digit of the bridge. That's what I'm going to do with my tooth gap. It's expensive but spares the teeth.


At any rate the abscess must be treated asap, else you're in danger of losing several teeth. Therefore I'd recommend a good dental clinic.

 

[dub]

Sorry Rhubarbodendron, I wasn't clear about a few points:

• The abscess did not clear up after treatment according to x-rays and the pain persisted, which is why he recommended going ahead with either extraction/implant or redoing the root canal.
• The root canal re-do was all four roots. The specialist told me one of the roots was not done all the way to the top the first time which could have caused my current issues, so she was more thorough. However a few months later, I'm still experiencing the same pain.
• The suspected crack would be beneath my existing crown. The x-rays cannot penetrate the crown. They can't just pop the crown off and check. They usually come off in pieces and would be expensive to replace (gold crown). I had a porcelain crown initially, but it broke after about 10 years. My new (current) dentist told me I could get a porcelain crown again which would be cheaper, but I'd likely be back in his chair 10 years later because they're not as durable as gold crowns. So I opted for the gold crown. Of course, that's going down the drain at this point.

A second opinion is not a bad idea though. Thanks for your feedback as well, propita!

 

[rhubarbodendron]

I see. Try to find a dentist with this new ultrasound equipment. These thingies can look through a crown and see if there's a crack. I suppose a big dental clinic or a rich dentist might have one. They seem to be rather new as I read about them in a medical journal only 1 or 2 weeks ago.

 

[dub]

Oh neat! Will do. Thanks!

 

[rhubarbodendron]

you're welcome