Dental Treatment Options for Complicated Cases

Dentistry

Hello.
I would like to describe the situation in writing.
The treatment involves four teeth, categorized as follows: (front tooth) left one, left two, (front tooth) right one, and right two.
The shadow area on the left is larger than on the right.
Since 1990, the left gum has developed small abscesses several times.
In mid-1994, the abscess shifted to the right side.
The most recent occurrence was on April 28.
I have noticed that when I feel weak or lack sleep, I tend to develop abscesses or experience inflammation and swelling.
The doctor assessed that if the dentures are removed and the pins are successfully taken out, root canal treatment can be performed on the four teeth (including the shadow areas) without the need for apicoectomy.
Currently, the dentures and pins have been removed, and it was found that the root wall of the left two tooth is cracked, the root wall of the right two tooth is too thin, and the root wall of the right one tooth is cracked as well.
The root wall of the left one tooth is okay.
X-rays show two shadow areas behind the root tips of the four teeth, with one on the right front tooth and one on the left front tooth (the shadows are quite significant).
Given the current situation, what treatments would be effective? Can the shadows be completely healed? Are there any potential complications? Is apicoectomy still necessary? This includes denture reconstruction and implants.
I have many questions and appreciate your help.
If X-rays are needed, I will pay for them myself; please let me know.
Thank you.
I have two questions to ask:
1.
If I only keep the left one front tooth, will surgery be needed for the black hole? (Because the root is 1.4 cm long.) Is root canal treatment feasible? Will I need an implant for the denture, or can I keep the right two front tooth?
2.
If all four teeth need to be extracted, and I am not considering removable dentures for now (I would like to keep my natural teeth as much as possible, as they are inherited from my parents), will I need implants? Thank you.

Xiao Jin, 30~39 year old female. Ask Date: 2007/05/09

Dr. Chu Boqin reply Dentistry

Dear Xiao Jin,
Hello! I would like to respond to your questions and provide some relevant suggestions.
Your detailed description is very clear: you have undergone endodontic treatment on your upper front teeth, and you are currently still in treatment.
You hope to have the tooth extracted, but your dentist believes that is not feasible and suggests you consider a dental implant, which has caused you some stress, correct?
Generally speaking, if the previous root canal treatment is not successful, it can be quite challenging to save the tooth.
If you wish to retain the tooth root, re-treatment is possible, but it should be handled by a specialist.
If a specialist in endodontics cannot save the tooth, extraction may be necessary.
After extraction, you can consult a specialist in implant dentistry for further dental implant options, with costs varying (possibly ranging from $5,000 to $10,000).
I hope you understand one important thing: while your dentist can help you achieve your desired outcome, it will require a significant amount of time, money, and, most importantly, patience.

Reply Date: 2007/05/09

More Info

Hello! Thank you for sharing your complex dental situation. Based on the details you've provided, it seems you are dealing with multiple dental issues that require careful consideration and planning. Let's break down your questions and explore the treatment options available for your case.

1. Treatment Options for the Four Teeth
From your description, it appears that you have four teeth that are in varying states of health, with some showing signs of root fractures and others having significant shadowing on X-rays, which may indicate infection or bone loss. The presence of abscesses and the history of gum issues suggest that these teeth may be compromised.

Root Canal Treatment: If the left central incisor (left one) is the only tooth that is structurally sound, it may be worth preserving through root canal therapy. This procedure involves removing the infected or damaged pulp from the tooth, cleaning the root canals, and sealing them to prevent further infection. Given that the left incisor's root is intact, this tooth could potentially be saved without the need for surgery.

Surgical Options: The shadowing you mentioned could indicate periapical lesions, which might require surgical intervention, such as apicoectomy (root-end surgery) if the infection persists despite root canal treatment. This procedure involves removing the tip of the tooth root along with the infected tissue.

Extraction Considerations: If the right central incisor and the second molar (right two) are too compromised (thin walls, cracks), extraction might be necessary. If these teeth are extracted, you would need to consider replacement options.

2. Replacement Options
If you end up needing to extract multiple teeth, you have several options for replacement:
Dental Implants: These are often the preferred choice for replacing missing teeth as they provide a stable and long-lasting solution. Implants are surgically placed into the jawbone and can support crowns, bridges, or dentures. They mimic the function of natural teeth and help maintain bone density.

Bridges: If you choose not to have implants, a dental bridge can be used to fill the gap left by missing teeth. However, this option requires the alteration of adjacent teeth, which may not be ideal if you are trying to preserve as many natural teeth as possible.

Partial Dentures: While you mentioned that you are not considering removable dentures, they are an option if multiple extractions are necessary. They can replace several missing teeth but may not provide the same stability as implants.

Long-Term Considerations
1. Healing and Maintenance: After any dental procedure, especially extractions or surgeries, proper oral hygiene and regular dental check-ups are crucial to prevent further complications. Given your history of gum issues, maintaining a rigorous oral hygiene routine will be essential.

2. Impact on Overall Health: You noted that your body feels weaker and that you experience symptoms related to sleep deprivation. Chronic dental infections can contribute to systemic health issues, so addressing these dental problems may improve your overall well-being.

3. Consultation with Specialists: Given the complexity of your case, it would be beneficial to consult with both an endodontist (for root canal treatments) and an oral surgeon (for extractions and implants). They can provide a comprehensive treatment plan tailored to your specific needs.

Conclusion
In summary, preserving your natural teeth is ideal, but if they are not salvageable, dental implants are often the best long-term solution. The decision to proceed with root canal treatment, extraction, or surgery should be made in consultation with your dental care team, considering both the current state of your teeth and your overall health. If you have X-rays available, sharing them with your dentist will help in making a more informed decision. Thank you for reaching out, and I wish you the best in your dental journey!

Similar Q&A

Affordable Dental Solutions for Long-Term Tooth Issues

Hello Dr. Tseng, I have the following question: My teeth have deteriorated due to lack of care, resulting in issues with all four corners of my molars, including missing teeth and root canals. After researching, I found that there are three options for reconstructing missing teet...

Dr. Zeng Guanghui reply Dentistry
Hello Jeff: If there are missing teeth or if a tooth has undergone root canal treatment, gaps in the dental arch can be filled using removable dentures, dental bridges, or dental implants. Removable dentures are more economical, but they do not provide as much biting force. They ...

Exploring Alternatives to Tooth Extraction for Severe Periodontal Disease

The doctor said that my periodontitis is severe, and the bone around my upper molars may be gone, suggesting extraction. I have the following questions: 1. Is there any option other than extraction? 2. I found information online about bone grafting and other methods to promote th...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Liu from New Taipei City, Hello! Dental issues can indeed be quite troublesome. If the condition is too severe, extraction may be necessary. I recommend that you visit a major hospital and consult a periodontist for treatment. They will provide you with a comprehensive ...

Effective Dental Treatment Options for Multiple Tooth Issues

Hello Dr. Liu, I have many dental issues and would like to know if there are any treatment options available. First, regarding the upper left side, I have a large cavity in one tooth (approximately the size of a thumb) and another tooth that has half of it affected, which also h...

Dr. Liu Tiancai reply Dentistry
Hello Mr. A-Hsu, regarding the issues you described, I can provide some general answers: For cavities, the affected part can be removed and filled with new dental material. The small tooth you mentioned may be a retained primary tooth that has not fallen out completely, which can...

Deciding Between Dental Treatments: A Patient's Dilemma

Recently, I received laser treatment for periodontal disease (costing 70,000 TWD), and the treatment has concluded (saying that laser treatment is painless is really misleading). However, there was no improvement (my teeth were very painful the week after the procedure), so I tra...

Dr. Wu Jinjun reply Dentistry
Hello: The treatment for periodontal disease currently relies on traditional methods such as plaque control, debridement of periodontal tissues, and effective oral hygiene education and training for better outcomes. The efficacy of lasers in the treatment of periodontal disease h...