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Dentistry/Implant vs. Root Canal


My lower left molar (#19) has been causing me problems for years.  It is a rather large tooth (9.7mm) which caused my orthodontist to have a lot of difficulty putting the band on it 35 years ago.  There was a lot of stress on that tooth at the time, and I remember it feeling as if the tooth would break.  I had braces 3+ years, and almost as soon as I had them removed, I was hit in the jaw by a hockey puck near that tooth.  Because my teeth were so loose still and I was wearing my retainer, they just moved around a bit.  There was no evidence of a crack in any roots.  However, I have never been able to eat anything hard on that side.  It doesn't hurt, but I just feel as if that tooth will give way.

A couple years ago, I felt as if that tooth were were not sitting correctly in my mouth.  My dentist said it seemed like an infection, but he couldn't pinpoint the location.  He put me on antibiotics, which caused the infection to burst.  After that, the area felt a bit better, but I haven't really eaten on that side at all.  

In the last year, I had pain off and on.  My tooth again feels as if it is not sitting correctly in my mouth.  The pain became excruciating for about 3 weeks and my dentist did a 3D x-ray.  He said the bone under this tooth seemed to be eroded on the inside and that the tooth would need to be extracted.  He felt that there was a crack from a long time ago that caused the bone to decay and caused all the pain.  I got a second opinion from an endodontist since this seemed so drastic.  He said I have 'dens in dente' in this tooth, but that the problems this caused could be helped with a rather complex-sounding root canal and a crown.  The tooth has a small filling on the side and a huge filling on top.  Besides these fillings, the only other dental work I have is a couple other small fillings in back teeth--not even a crown.  I also found out I had a bad ear infection, too, which has now been treated.  That caused the pain to lessen.

I decided to wait, but in the last two weeks, it is really hurting again.  My ear is okay, so it is obviously the tooth.  The pain causes pulsing in my nerve off and on.  I am really thinking extraction with an implant is the best route to get rid of this messed up tooth, but then I get upset that I will be losing a tooth.  I had thought I would keep them a lot longer in life.  At 45, it seems as if I'm starting down a bad path.  On the other hand, I can't even remember what it's like to eat on the left side.  

I know you can't tell me what to do and obviously don't know if it is cracked, but I really feel confused about this.  Also, I have a nickel allergy.  I know the implants use titanium, but wondered if that could still be a problem.  I only had a problem with my braces when I put my hand against them for a long time and got a rash there.  Finally, I know the implant post is not nearly large enough for a tooth that size, so there will be gaps near the base.  Is that going to be a problem?

Thanks for any advice!!

Hey Christine,
Sorry to hear that this tooth has been causing you so many problems. Based on your description and the history, I would agree that there is an irreversible problem with the tooth. While "PERHAPS" there are some treatments (antibiotics, root canal surgery, curettage) that may prolong the life of the tooth and relieve some of the symptoms, I feel that ultimately this will be an ongoing problem for you and eventually require extraction.
Therefore, I would like to suggest that you put this entire saga behind you and move on.... get an implant done well, and this will not be an issue for you anymore.
Joseph Zelig


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Joseph Zelig, DDS


Dr. Zelig is a board-certified Periodontist and is an expert on dental implants & treating patients with Dental Phobia. Dr. Zelig can answer any and all questions you have about complex dental problems, dental implants, gum disease, treatment of gum recession, and IV sedation dentistry.


Dr. Zelig has personally placed several thousand implants with excellent success and has worked with many dental specialists and educated them on full mouth reconstruction, esthetic dentistry, and Sedation Dentistry. Dr. Zelig is a coauthor of a book on Dental Phobia, "The Fearless Smile: Overcoming Dental Phobia"

American Academy of Periodontology, American Board of Periodontology, North-Eastern Society of Periodontists, American Dental Society of Anesthesiology

I received both my dental degree (DDS) and my certificate in the specialty of Periodontics from New York University College of Dentistry. Dr. Zelig graduated among the top 10% of the graduating class. As a result of outstanding academic achievements, Dr. Z was elected into the membership of Omicron Kappa Upsilon- the national dental honor society. In addition, Dr. Zelig has lectured to general dentists and specialists on periodontal treatment and dental implants. He is a Diplomate of the American Board of Periodontology which recognizes periodontists who have made significant achievements beyond the educational requirements of the specialty. Board-certified periodontists have been examined by a panel of internationally respected peers and has been awarded Diplomate status. By successfully completing this challenge, Dr. Zelig has demonstrated a robust knowledge of periodontics, Continued professional development, Critical review of results of therapy, and interest in providing the best, most up-to-date care.

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