UKC

Any dentists in the house?

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 Martin W 16 Dec 2015
I'm getting confused with advice from multiple dental professionals and I was wondering whether there might be someone on UKC who could help me work out what to do.

I had an abscess in my left upper 6 a few weeks back - this is a tooth which was root filled and crowned about six years previously. My dentist prescribed antibiotics, which cleared up the infection, but she also took an X-ray and thought that the tooth looked like it might have a hairline crack in the root. She recommended that I see an endodontist for further investigation and advice on treatment for the longer term.

The endodontist she referred me to also took an X-ray, and confirmed that there was an ongoing risk of infection in the root - although he said that he couldn't detect a crack on the X-ray. He advised treatment involving drilling through the crown to examine and, if necessary, repair the root.

By chance, a personal contact of mine knew of another endodontist in the area and suggested approaching them. This time the X-ray showed that only three of the expected four roots had been filled. Again, no clear indication of a crack was seen. The recommended treatment this time was to remove the crown, to allow the root to be examined and, if it looked feasible, to replace the original root fillings and fill the root which had been missed the time before. The estimate for this was less than for the "drill through the crown" approach, but would require new crown to finish the job, bumping the cost up.

The other option outlined to me by my dentist would be to have the tooth out and either leave a gap (the first endodontist advised against this, due to the way my teeth come together) or have it bridged - which I understand involves fitting crowns to the teeth on each side of the gap. A bridge would be more expensive than a root repair - but a repair might not work, or might not last for long. (I believe the other alternative to fill the gap would be to get an implant, but that would be even more £££££).

I'm confused because the diagnosis and recommended resolution seems to have been slightly different at each consultation. Any one of them would be expensive, so I want to make the best choice - but I've no idea which that would be!

Any suggestions or guidance would be very welcome...
 Dr.S at work 16 Dec 2015
In reply to Martin W:

Not a dentist, but an enthusiastic user of their services:

Firstly - have all three x-Ray's looked at by one of the endodontists - radiographs are a 2d representation of a 3D object and slightly different views can give different information. The dentists should all be happy to share the images with each other. It makes sense to ensure whoever guddles about in your gob has as much info as possible.

The two approaches to examining the root are variations on the same theme - ask the endodontists you like best why they use the procedure they advise rather than the alternate. If possible ( and the data may not exist) ask for success/complication rates of the two techniques in the general population and the individual practitioners hands.

I'd defer bridge vs hole vs implant until the roots been thoroughly looked at again. I'm prejudiced towards implants as both parents have had bridges which have caused a fair bit of grief, but implants are costly as you say. Again though, try to get clear data on cost/success/complications upfront.

HTH




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