Expert: Frederick R. Liewehr DDS, MS, FICD - 9/30/2004

Question
Hello Dr Liewehr,

    I'm a bit baffled by my dental treatment and wondered if you could set me straight.
    In July of 2003 I had a root canal and crown performed on tooth #21. In May of this year I had periodontal scaling performed and as a result was advised I had infection under tooth # 21. I was referred to periodontist who tells me I need a dental implant on said tooth. Or alternatively I could get a bridge, but this was not the preferred method of treatment.
    I don't understand how I can need additional treatment. Is this because the root canal and crown were not treated effectively in the first place? If this is the case, would I have any recourse? Also, Of the two recommended treatments which I am now faced with which would you recommend and why. I do not have insurance to cover the implant, but wondered if it would be foolish to get bridgework done.
    Thank you for any expert advice you can offer.


Mike  

Answer
Hi Mike,
    It is unfortunately impossible for me to tell you exactly what is going on with tooth #21 without seeing and examining you and reviewing past and present radiographs. However, I will try to take a few guesses.
    When you had the root canal therapy on #21 in the first place, there was a reason, but I don't know what it was. Since that procedure makes a relatively large hole in the top of your tooth, and the reason for the root canal usually is a big cavity, a crown is often placed to make sure that the tooth doesn't fracture when you bite on something.
    Root canals are like anything else; sometimes you don't heal properly for one reason or another, so the success rate is not 100%. This is true for any medical or dental procedure. However, when you were told that you have "infection under tooth #21", I don't know what that means, because you could have an endodontic or periodontic infection, and the cause and treatment would be quite different. So we don't know what the causality is. And, if it is of endo origin, we don't know that the only recourse is to take the tooth out, which is what the periodontist is offering. Of course, root canals are not his specialty, so he probably is not the person to advise you about that tooth. You need an endodontist. There are often other options.
    As for the choice between an implant and a crown, if done properly either one could give you a good result. The implant avoids a lot of drilling on the two teeth on either side of the missing one, but if there is a huge filling on one or both, then it would not be so bad, as it would be like crowing those teeth. Usually, however, #20 and particularly #22 would not have huge fillings, so an implant might be more conservative. On the other hand, the implant requires at least two separate surgeries, and involves some additional risks.
    Bottom line is that I would consult an endodontist and find out why the periodontist wants to take your tooth out; whether it is a perio problem for which there is no other solution, or whether it is an endo problem that he can fix for you. The most likely thing I can think of is that your tooth is vertically fractured. If that is the case, then it does have to be removed. As for restorative options, either one is a good choice. I don't think you could go wrong with either. Good luck!
Dr. Liewehr