Does the x-ray show both teeth are infected? (Photo)

Question

I had root canal 5 yrs ago for lateral incisor and cuspid, and I was told both need to come off and have dental implant, but I'm only seeing a bump or sometime small pus (it looks like it) on the gum above the cuspid, the gum above the incisor looks fine, I'm afraid I'm being misdiagnosed for the incisor, it looks healthy to me. Can you confirm the x-ray, please, need help!! Thanks so much!

Zev Kaufman, DDS · Answer

Dear jaderc: The  problems you have are not caused by the poor root canal treatment.  If  you look carefully around the crown of the canine, you would notice that the crown does not fit the tooth properly and does not cover the root structure. On the contrary there is a void all around the crown and that is probably why the root canal treatment leaked and got re-infected. The correct course of action is NOT to get root canal treatment or extract the teeth.  The correct process is to first take an antibiotic such as Amoxicillin (if you're not penicillin allergic) for ten days.  As you start taking the antibiotics, have your dentist remove the existing crowns and evaluate whether the teeth can be restored again after all the recurrent decay is removed.  If after all the decay is removed you have good tooth structure remaining, the root canal treatment can be redone, a new gold, cast post-core can be fabricated and new single crowns can be made. If there is not enough good tooth structure remaining (canine is a problem), then the tooth can be removed and replaced with a dental implant.The best person to go to for this is the specialist in restorative, cosmetic, and implant dentistry, the prosthodontist. Best wishes,

Nirav Patel, MDS, PhD · Answer

u can go for reRoot  Canal Treatment and/or apicetomy. no need to go for implants. by these procedures u will save yr natural dentition.

Victor Sanz, DDS · Answer

You can wait on the incisor if there are no symptoms. Another option you can consider is an apicoectomy & keep your tooth. Good luck

Paola Annoni Patel, DDS · Answer

From the looks of the x-ray and photograph, there are a couple of factors at play here. I'll address the cuspid first. Both clinically and radiographically, you seem to have active infection. The dark shadow around the apex (end of the root) in the x-ray and the active pus drainage are indicative of infection. The other point of concern relating to the cuspid is the crown. If you look closely at the x-ray, you can see a pretty significant, continuous gap around the entire margin of the crown. This is allowing bacteria to access the tooth directly and has greatly compromised its prognosis. You can even see that you've had some bone loss around the tooth, especially between the lateral and the cuspid. I do not think it is salvageable. The lateral also has a few issues, though it is not as severely compromised as the cuspid. If you look at the apex of the root of the lateral, you'll notice that the root canal filling goes way beyond the end of the tooth, and surrounding that excess filling is a dark spot- that is infection. You'll also notice a dark halo at the margin where the crown meets the tooth- this is an open margin. Though the open margin on the lateral is not quite as aggressive as the one on the cuspid, it is still there and has exposed your tooth to bacteria and infection. The lateral seems to be on the same path as the cuspid.... taking care of it now may prevent further bone loss and infection development. There is the option of retreatment of the root canal in the lateral, but the bone loss and the lack of remaining tooth structure (from what I can discern in the x-ray), does not look favorable in terms of long-term prognosis.In order to prevent more bone loss, and the possibility of one or both of your crowns breaking off during normal activity, I would be inclined to agree with the treatment option presented to you by your dentist. The area would benefit from extractions of the lateral and cuspid, grafting (to gain more bone, as you've had some loss), and implant placement.Good luck!

Herbert Veisman, DDS · Answer

Hi there. For you have pus, there is an infection and you need to see an Endodontist or a periodontist. Once you have been told whether the root canals can be retreated then you can decide on the course of treatment with extractions, bridges, or implants as options. Let me know if you have any other questions.

Sue Wendling, DMD (retired) · Answer

There is infection at the ends of the roots on both teeth. From the xray, the cuspid looks like a goner. However, the lateral looks like it could be saved. Have it evaluated by a good endodontist.

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