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QUESTION: Dear Dr. Teig,

I am a 60 year old woman who has the last molar on the upper left with a crown and a root canal.  The tooth next to it also has a crown and root canal and they are very close to one another--so close that one cannot floss very well and over the years I have had a lot of sensitivity in the gums between these two teeth with lots of bleeding.  Now a new dentist informs me after 24 years that the gums around this last molar has pockets of 9-10 in depth and periodontal disease just by these two teeth.  I had a deep cleaning and a periochip inserted between the two crowns today.  The dentist also sees a crack in the tooth along the root.  I remember when my dentist in the US first did the crown and root canal, he said you have a crack in the tooth but I am going to do what I can to save it and I wanted him to do this.  It lasted 24 years.  Now I have this periodontal disease and the dentist here in Israel recommends it be extracted and an implant put in place.  This is the last molar on the upper left.  Should I continue with the deep cleanings and periochips to see if we can get the gums healthy between these two crowns or because of the crack in this last molar to have the tooth extracted and an implant put in place?  I am worried that the extraction of this cracked tooth with the crown and the root canal may be difficult.  Is that the case? Is this tooth being cracked in danger of an abscess even though it has a root canal?  The gums are presently inflamed but I just had a deep cleaning between the two teeth today.  The dentist said this is a tuberosity and may need a bone graft?  What does that entail and is it safe?  Is it a good idea for me to have this tooth extracted and an implant put in its place?  What is the danger that the other tooth next to it may be damaged during an extraction?  What would you recommend?   Thank you for your advice.

ANSWER: Sharon - It is, of course, a little difficult for me to be completely sure what the best treatment would be.  If that last molar is truly cracked, then extracting it is important to eliminate any inflammation or infection associated with it.  That extraction would also help to reduce the chance of that inflammation or infection spreading to the other tooth.  

So having the extraction is probably the appropriate treatment.  I am a very conservative doctor and do not believe that any graft material or implant be placed immediately after the extraction of the problem tooth.  I recommend that after the extraction the site be left alone to heal for about 1-2 months to be sure that no residual infection or inflammation exists.  At that time a graft can be placed and an implant also.  

The adjacent tooth itself will not be damaged from that last tooth, but the bone surrounding and supporting that second to last tooth could be damaged.  For that reason, the source of the problem, the last tooth, should be extracted.  

So don't let yourself be rushed into a replacement, if there truly is infection or inflammation, until the area heals.  If you have any additional questions, feel free to contact me again.

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Teig.  Do you think it is possible for me to just treat the periodontal disease at this time and not do an extraction?  I understand now the number of the pocket is 3,5,8 around the last molar.  I am worried about an extraction because I have unusually long roots, the proximity to the sinus, and what is the tooth splits when it is being taken out, etc.  If the crack has always been there, why should it be replaced now after 24 years?  The dentist here said the endodontist gets an "A" on her root canal.  Does it mean this root canal is now failing or perhaps I am just not cleaning good enough.  Perhaps with an extensive routine of deep cleaning, periochips and/or gum surgery and good home health care would I be able to reverse the situation back to a manageable situation without extracting the tooth? Please advise.  Thank you.

Sharon -  If the cause of the problem is periodontal, then periodontal treatments should help, but if excess bone has been lost, the situation will return no matter how well you maintain it.  

I wish I could tell you more if an extraction or just treating it will be sufficient.  I don't know what the dentist said and what he meant.  You need to have the doctor be exacting and honest with you to determine if the tooth should be saved.  You need to make an appointment and write down all your questions and have the doctor answer them.  That would be the best way to know what the appropriate treatment should be.

I wish you well.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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