#13 tooth has a root canal, no crown. Have discomfort around tooth in the sinus area.

Question

One x-ray shows crack and another no crack. One dentist (crack) want extraction, bone craft and implant, the other (no crack) says sinus infection, I have been taking sinus meds for 2 days (2 pills every 4 hours) and no sign of pain improvement. I saw both x-rays, that is what makes this so strange.

Sarah Thompson, DMD · Answer

If you were my patient, I would recommend continuing the sinus meds for the full 7 or 10 days, depending on your prescription duration.  I would then determine if the pain has been resolved completely, or if it is still lingering.  If their is still pain, I would have another radiograph taken to see if another doctor can find a crack.  If, no crack, then you may need a retreat of the same root-canal.  If you do have a crack present, then I would recommend replacing the missing tooth with an implant or a 3-unit bridge.  If you choose the 3-unit bridge, you will avoid the need for bone grafts and have something that functions and looks very well.  3-unit bridges are generally done in 1-2 appointments and patients love them.  Good luck and I hope this helps. Follow me if you have more questions.Sarah Thompson, DMD

Kathy Frazar, DDS, FAGD · Answer

X rays often cannot give us a definitive diagnosis.  A 3D Cone bean image would give a better picture.  A blood test would show an elevated CRP (C Reactive Protein) if infection was there.  My bet is that you will need to have the tooth removed and have an implant placed.

H. Ryan Kazemi, DMD · Answer

CBCT (cone beam CT scan) will provide some important information on:1. Possible diagnosis of fracture (crack)2. Maxillary sinus- Whether or not there is fluid or other forms of sinus pathology that can be related to sinusitisAlso, an endodontist with use of microscope can examine the tooth closely for fractures. They are sometimes obvious through a microscope.Dr. Kazemi

Jonathan M. Abenaim, DMD, DICOI · Answer

Dentistry and Dentists are very variable. Seeing a crack on an X-ray unless it is obvious is very difficult to see. The best way for anyone to see what is going on is having a Ct scan taken of the area and having a full occlusal exam done. Root canal treated teeth with no crown have a high probability of recurrent infection and most importantly fracture. Find a dentist you trust and make sure you are in good hands.

N. Summer Lerch, DDS, FAGD - Account Suspended · Answer

Upper side teeth can sometimes affect the sinus. With root canal treatment and the possibility of the a fracture, diagnosing the exact problem can be difficult.  And radiographs taken on different machines, at different days, by different staff, and at different angles can often show different information. (Unfortunately this is not very strange in our field.)  You are doing the right thing.  If you can tolerate the pain, then stay the course of your antibiotics.  Giving them the full time to be effective will give you and your doctor the best possible information to make a diagnosis.  If you have a fracture, the only treatment is extraction.  Therefore graft / implant might be your best treatment.  If you do not have a fracture, and you have a failing root canal, you may want to retreat.  If it is sinusitis, then the antibiotics should help that go away and you could be pain free.  You are taking the right action now.  Give your body and the meds some time.

#13 tooth has a root canal, no crown. Have discomfort around tooth in the sinus area.

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