Expert: Benjamin Schwartz, DDS FAGD - 2/10/2009

Question
Hi Dr. Schwartz, I had a root canal (with an abscess prior to the root canal) and crown on tooth #29 around 02/07. I continued to have some discomfort in the tooth when it was pressed. I was sent to an oral suregeon who did an apicoectomy on 06/07. Since then I have again had sporadic discomfort in the tooth. Sometimes it feels like the gland under the jawline near that tooth is swollen, however it does not routinely hurt when I chew on it. If I get a cold, I feel pressure in that tooth area.
The last time my dentist did an x-ray there he now says he sees a small fracture in the tooth, where previously he said there was not one.
I have also had tooth #30 removed and also 31 in the past. I am probably going to need an implant or two.
My question is does it sound like #29 should be removed based on the symptoms, with the liklihood of having an additional implant or should I seek another opinion?
I am also going to need some straightening of my front teeth as they are splaying. Should I correct the other issue first, have the implants then go with the aligning?
(p.s. I am 60 yrs old). Sorry for this long question. I appreciate any help you can give.

Answer
Hi Jean,

It's possible that the tooth is fractured.
Often, fractures don't appear on xrays, as they are vertical. An xray is a 2-dimensional image that doesn't show a vertical fracture well at all.

At this point, I would probably take out #29 also and have two implants placed and restored with a 3-unit bridge between them.

I would first take out the affected tooth (#29), then do the alignment, then proceed with the implants.

Please let me know if you need more help.