Tooth 13 extraction and question on 14

The efforts and costs to save these teeth may be better served by simply removing them both and placing implants now instead of later.  This will preserve bone and avoid the pain expected later.

 

The cost to redo the root canal and make a new crown will be similar to the implant route, but with a higher success rate.

It sounds like you are going through heroic efforts to try and salvage these teeth.  The best long term prognosis for restoration of these teeth would be for extractions and bone grafts with implant placement. You are putting a lot of time and expense into a treatment that does not have a good long term prognosis.  Implants would be your best long term option and most cost effective over the long term

If you want to phase things over a period of time, you can do the crown lengthening on 13 with a new crown.  Follow that by taking a wait-until-it-hurts approach on #14, which may never happen.  There is some risk of one or possibly both teeth failing and needing further treatment in taking this approach.

 

If you want to simply eliminate structurally compromised #13 and take care of the "potential" problem of  #14, have both #13 and #14 extracted, place implants and restore with new implant supported crowns on #13 and #14.  This approach is a forward thinking, long-term result oriented treatment.  Implants will be more stable with minimal risk of ever giving you problems in the future.

Based on this x-ray (without clinical exam), tooth #13 seem to have a limited support for a new crown. Extraction and Implant may be your better option to save future dental visits.


Tooth #14, however can be treated later, if there is no active infection and existing crown is sealed well. Root Canal Retreatment and a new crown OR extraction and an Implant will be your two choices for tooth #14, if needed.

It's hard to say from just this x-ray, but here are the things I talk to my patients about to help them choose the best treatment for them.  First -- consider that whichever treatment options you choose, the investment is going to be significant, so make sure you are in very good hands. 

(since I can't see the rest of your x-rays or do a clinical exam, this consultation is just an estimated opinion)

Reviewing your x-ray, here are the options I can see :

(I'm assuming that #13 is not decayed or fractured way below the gum or bony socket)

1.  Save #13 with crown-lengthening, build-up and porcelain crown.  Leave #14 alone since it is has no symptoms.  (if you have a definite infection/abscess at the root tips of either tooth, then you would need to retreat the tooth first -- and I would use an experienced endodontist to do that)

 

2.  Extract and implant #13 -- leave #14 alone.  (If #14 has an active infection or is causing you problems, then I would recommend treating it).

 

3.  Immediate load implants have a lower success rate than progressive load.  (you can have a small temporary tooth that clips into place so that you won't have a gap while the implant settles in)

I hope this was helpful!

Sincerely,

Dr. Susan Estep