Thanks for attaching the xrays! Your situation is very common... I'll explain what is happening.
The first thing to keep in mind is this..... root canaled teeth will always harbor infectious bacteria inside of the microscopic canals because these tiny canals cannot be cleaned out during any dental procedure. Therefore, this nerve material becomes sick and necrotic. Antibiotics cannot kill bacteria that is embedded inside of the tooth. So irrelevant of what is done to the tooth or bone around this tooth, the tooth will always remain infected.
Secondly, anytime you develop a fistula above a tooth, there is an infection. Fistulas form due to an overwhelming amount of bacteria. This is the body's way of finding an outlet to release some pressure from the infection. For a fistula to form, the bacteria proliferates from the tooth, burrowing a hole through the jawbone and out through the gum tissue. This does not mean the infection has left the tooth......... it just means some pressure has been released. If a fistula did not form and/or the pressure was not able to release some other way, there would be a large swelling.
Thirdly, the paper point that was used to indicate the path of infection is quite evident. Radiographically, there is pathology at the apex (end of the roots) of this tooth. That is an additional indicator that this tooth is infected and the bacteria has proliferated through the tooth into the jawbone.
This tooth is near your sinus. There may or may not be a sinus exposure during an extraction at this time. However, the key thing here to know is this.... the infection will continue to spread causing additional loss of bone around this tooth which would make a sinus exposure more likely in the future if you wait to remove this tooth.
With regard to replacing this tooth.... chances are the teeth along side of it, #'s 2 and 4, will start to move towards the open space which would cause a shift in your bite. This can take years to occur, it just depends on the individual. Another key thing to know here is this.... if you wanted to replace tooth #3 with a dental implant you would need to have adequate healthy bone for the implant to be successful. The longer this infection goes on, the more bone loss will occur which could result in a much more complicated situation for replacement of the tooth. Also, if you extract it and wait a year or two to place an implant, the bone may have recessed back too far to hold an implant and your sinus may also have dropped down into the space at that point. Does that make sense .... or do you need some clarification on that?
I'm sorry if your dentists have not informed you of any of this....that is not unusual, however they certainly should have by now. Hopefully this information will help you to discuss your situation more fully with them and enable you to make an informed decision as to what you feel is in your best interest.
Please let me know if you have other questions.... I'm happy to help if I can!
I'm sorry that your dentists have not informed you of these things.
Originally Posted by sbbi
I had a root canal retreatment at the end of last year on tooth #3. About 2-3 weeks after that, a fistula (bump) developed on the gum above the treated tooth. The endodontist thought the MB root is cracked and suggests root amputation. Please see the x-ray attached.
I decided to seek 2nd opinion. About 2 weeks ago, my periodontist did an exploratory surgery but he did not find crack on the root. he told me there was significant bone loss so he did the bone regeneration with graft material.
however my periodontist was not clear where the source of the infection was. He said he did not know the whole history of the tooth and there might be crack inside the root.. he does not think apicoectomy is needed since he thinks the RC retreatment has reached to the end of the root. And since he has done the exploratory surgery I believe he should have cleaned up the gum (I need to check with him). My endodontist did tell me that he saw infection inside the root but he did not see crack inside the root. So I do not know what to do now..
Also, the situation has not got any better after the surgery. I feel tooth #3 "sticks" out, meaning it feels longer than other teeth so when i clench my teeth, the teeth at the right side (or tooth #3) touch the bottom teeth first. The symptom is slight in the morning and gets worse during the day. so in the PM, I will feel some slight pain at the root end when I clench the outer part of tooth 3 (the area which I think corresponds to the MB root?) I actually had this problem before the surgery, but the symptom went away when i took antibiotics. However, after the surgery the symptom resurfaced even when i was still taking antibiotics post-procedure. The fistula has gone, but my gum in that area is still swollen since the surgery. According to what I read online and it seems that it is the membrane surrounding the roots is infected.. what do you think? Can this be viewed as the cause of the whole problem (Fistulas..)? how should dentist treat this?
I tend to lose hope on this and I guess i should just have the periodontist extract the tooth.. BTW if tooth #3 is extracted, do I need to worry about sinus perforation?
Thank you so much!