Comprehensive Guide to Root Canals, Bridges, and Wisdom Tooth Extraction

Root canal treatment, braces, wisdom tooth extraction, and missing teeth issues?

Hello Doctor: My questions are a bit complex and lengthy:
(1) I have a lower right first molar that underwent root canal treatment a long time ago and has not yet been capped.
The X-ray shows a white area, and the doctor said it appears to be cavity-free at the moment, but since the root canal may not have reached deep enough, it needs to be monitored.
If I want to get a crown, will I need to undergo root canal treatment again? Given that the X-ray shows a white area, should I go to a major hospital for more precise imaging?
(2) My left first molar had a root canal in late May (still not capped), and the adjacent left second molar was extracted in July due to decay found after the old crown was removed.
The doctor recommended extraction because there was no tooth structure left on the inside, stating that a crown would lead to frequent inflammation and pus formation.
The doctor suggested either an implant or a bridge, using the first molar (which has had a root canal) and grinding down the second premolar.
Is this bridge stable enough? I am concerned about maintaining the bridge and the risk of decay in the supporting teeth, which could lead to needing extractions again.
How can I thoroughly clean the teeth involved in the bridge?
(3) My lower left wisdom tooth is growing well, but it appears to have some minor decay (it looks dark, and I can't brush the outer side near the cheek well).
I consulted with other orthodontic clinics, and the doctors suggested using the lower left wisdom tooth to replace the second molar.
Currently, I need to have my upper left wisdom tooth extracted.
A few days ago, I went to a highly regarded oral surgeon for wisdom tooth extraction, but the doctor recommended that I go to a major hospital with an ENT department (since the clinic does not have one).
The doctor expressed concerns about potential postoperative issues and even questioned whether I really needed to have it extracted, suggesting it might be safer to leave it alone.
However, he assured me that he could extract it cleanly and that healing would be good, but he emphasized his concerns about the follow-up.
My upper left wisdom tooth is very close to the sinus, and I have some nasal allergies, occasionally blowing my nose or sneezing in the morning.
I left without the extraction.
If I have to sneeze or blow my nose after the upper wisdom tooth extraction, what should I do? Due to work commitments, I only have flexible time during summer and winter breaks.
I feel that after extracting the upper left wisdom tooth, I would need more than a week for rest and observation, so I am hesitant to proceed with the extraction.
However, I am worried about the lower left wisdom tooth decaying further.
What can I do to protect it, especially since it is difficult to brush the outer side?
(4) I have a missing tooth in the lower arch (left second molar), and I feel a tightness when biting down.
Is it acceptable to leave this gap without a bridge while waiting for orthodontic treatment?
(5) What is the success rate of autotransplantation? An orthodontist mentioned that the lower left wisdom tooth could be transplanted to the left second molar position, but the doctor emphasized that it may not be successful.
I would like to understand its success rate.
Thank you for addressing my questions!

Yan Yan, 30~39 year old female. Ask Date: 2019/08/17

Dr. Huang Tingfang reply Dentistry

Dear Miss Yan Yan,
Hello!
(1) The lower right first molar, which has undergone root canal treatment a long time ago, needs to have the root canal therapy redone before placing a crown to prevent future swelling and pain.

(2) The lower left second molar was extracted this July, and it is advised not to place a bridge, as it could damage the lower left first molar.
Additionally, for a bridge to be successful, proper oral hygiene is essential to avoid cavities.
(3)(5) Is it possible to use the lower left wisdom tooth as a substitute for the second molar? It may not be successful, as there is a risk of root infection and resorption.
The success rate is generally higher in younger individuals.
The upper left wisdom tooth can be extracted, even though its roots are close to the maxillary sinus.
(4) Orthodontic treatment can help resolve crowding issues.

Take care! Wishing you peace and smooth progress!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2019/08/17

More Info

Dear Patient,
Thank you for your detailed questions regarding your dental concerns. I appreciate the complexity of your situation, and I will address each of your inquiries systematically.

1. Root Canal Treatment and Crowns: For your lower right first molar that has previously undergone root canal treatment, it is essential to ensure that the treatment was thorough. If the X-ray shows a white area, it may indicate that there is no current decay, but it does not rule out the possibility of residual infection or issues below the root. Before placing a crown, it is advisable to have a dental professional evaluate whether a retreatment of the root canal is necessary. Advanced imaging techniques, such as a cone beam CT scan, can provide a more detailed view of the root structure and any potential issues that may not be visible on a standard X-ray.

2. Dental Bridges: Regarding the left side, where you have had a molar extracted and are considering a bridge, it is crucial to understand that the stability of a bridge depends on the health of the supporting teeth. If the first molar has had a root canal, it may be structurally compromised. The second premolar will need to be prepared, which involves some reduction of the tooth structure. Proper oral hygiene is vital to prevent decay around the bridge. Regular brushing and flossing, especially using interdental brushes or floss threaders, can help maintain the health of the supporting teeth and the bridge itself.

3. Wisdom Teeth Management: For your lower left wisdom tooth, which has some decay and is difficult to clean, it is crucial to maintain its health as long as possible. Regular dental check-ups and possibly fluoride treatments can help manage early decay. If you are considering the extraction of your upper left wisdom tooth, it is understandable to be concerned about its proximity to the sinus cavity. If you experience sneezing or nasal congestion post-extraction, it is essential to avoid forceful actions that could dislodge the blood clot and lead to complications like dry socket. Discussing your concerns with your oral surgeon can help you prepare for the procedure and recovery.

4. Missing Teeth and Orthodontics: The absence of your lower left second molar can affect your bite and lead to discomfort. While waiting for orthodontic treatment, it is essential to monitor your bite and any shifting of teeth. If you are experiencing tightness or discomfort, it may be beneficial to consult with your dentist about interim solutions, such as a temporary bridge or partial denture, to alleviate the pressure and maintain proper alignment.

5. Autogenous Tooth Transplant Success Rates: The success rate of autogenous tooth transplantation, such as moving your lower left wisdom tooth to the site of the missing second molar, can vary. Generally, younger patients have a higher success rate due to better healing capabilities. However, the procedure's success also depends on the condition of the donor tooth and the recipient site. It is crucial to have a thorough evaluation by a dental professional who can assess the viability of this option based on your specific circumstances.

In summary, your dental health requires a comprehensive approach that includes regular monitoring, proper hygiene practices, and timely interventions. I recommend discussing these options with your dentist or a specialist who can provide personalized care based on your unique situation.
Wishing you the best in your dental health journey!
Sincerely,
Doctor Q&A Teams

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