Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 1/19/2007

Question
Thank you very much for the suggestion.  So - you've actually seen a similar situation and the apico was the remedy?

Also - since 14 is not rct - can an apico be done first or does rct always preceed the apico?  14 is so similar to what 3 was a year back - cold sensitive, bite sensitive on hard chewing surfaces (q-tip bite hurst upon release) - calcified, with absolutely no x-ray evidence of...anything!

Thx again.
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The text above is a follow-up to ...

-----Question-----
#4 is extraced.  #3 started to bother me 2 years ago when I would 'grind it just the right way'.  August of 06 it began to ache, etc.  Deep roots, seated in sinus cavity, all calcified.  Had RCT under microscope.

Was great until 12/20/06  - became sensitive to sweet and cold...odd.  We removed the crown - found nothing.  However, seating the temp crown didn't work as the pain was intense.  No outward signs of fracture but all of the symptoms.  

Saw a very good oral surgeon who wanted to wait and see.  Got a temp on - put it out of occlusion - since then the cold issue is gone, sweet is gone, and I don't hit it with hard things since we've kept it lower.

#14 acts the same way as this one did 2 years ago.  It is anchoring a bridge with #12.  Calcified.  In the sinus cavity.  Sensitive to cold.  And it has the crack symptom of hurting as I let off of a bite down on something.

I'd rather not do implants because both would require sinus lifts.  But I also am not going to stay on the pot for months on end.  Any ideas on your end?  btw, antiobiotics did nada and my sinuses are clear....!

Thanks
-----Answer-----
Bob - When someone has the development of roots that closely integrate with the sinus cavity, the sensations are altered.  In most situations where I see a previously root canalled tooth with sensitivity and close to the sinus, I first try doing a procedure called an apicoectomy.  In this procedure, the tips of the roots are sectioned off, the canal of the tooth is sealed from underneath.  If the surgeon is good and experienced, this procedure usually has good results and the tooth is saved.

Of course, implants can always be done, but the apicoectomy can be done with no sinus lift procedure needed.

If you have any further questions, please feel free to contact me again.

Answer
Bob - Apicos are usually the first remedy used to retain the natural tooth if at all possible.  I myself have done many and two were done on me.  Twenty years later everything is still okay.

As far as the second tooth that is sensitive and does not have root canal treatment yet, I would first definitely get that tooth neurologically tested by an endodontist.  If the nerve is not vital then root canal should first be attempted.  If, however, the nerve in the tooth is vital, an evaluation by an ear, nose and throat doctor may be a good rule out of a chronic sinusitis which can often mimic the type of pain you are describing, even for the old root canal tooth (that is as long as there is no evidence of an infection at the end of the root.

Again, any more questions, don't hesitate to contact me again.