Oral Surgery/Implant


Dear Dr. Ryan,

I had root canal done twice on tooth #14 with a few years apart in between. It has been good for 5 years since the second treatment. Recently my primary dentist told me during the routine cleaning that she saw some abscess on this tooth from the xray and suggested me to take it out. I have no symptom, no pain, no drainage, and my gum is in good condition. She said since I had root canal, I would not feel the pain. Then I went to see an oral surgeon to seek second opinion. He took a panoramic and found this tooth was in no worse condition compared to the one taken a few years back. He also told me that some patient will always have abscess shown in their X-ray.

My question is shall I start planning on taking this tooth out now or can I wait until my have pain, gum infection or other symptoms? There is a possibility I may need bone graft and sinus life as my sinus is low. It is always my preference to preserve my nature tooth.
Your insight will be very much appreciated.
Thank you!


Wendy, thank you for your question. It is very possible for the radiograph to show a residual cyst once the root canal is performed. Additionally, you can have an ongoing infection in the bone and it would not hurt because you had the root canal. Both of your doctors are correct. Your general dentist sent you to a specialist for their specialized opinion and I agree with the recommendations of your surgeon. As long as you have an initial radiograph to compare the new radiographs with than I would keep the tooth. It would be worth wile to get an x-ray every year if you do not have pain to just compare and see if any changes are taking place. If you start having pain then I would start planning on removing the tooth. I hope that helps. Great question.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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