Why does it hurt? I had the root canal.

The Presentation

An existing patient of my practice presented today complaining of soreness on chew, especially something hard. “It hurts somewhere up there, on top to the left”, she said.

The Analysis

The first thing to remember; there was no swelling of the patient’s face, nor around the gum of the teeth in question. Another key point, was that there was no response to cold or hot stimuli. Specifically, the patient exhibited a dull pain upon chewing down on my carefully positioned cotton roll. Subsequently, a radiograph of the maxillary first molar area was taken by my assistant. Behold! Not to mention, THIS TOOTH WAS PREVIOUSLY TREATED BY ME WITH ROOT CANAL THERAPY SEVERAL YEARS AGO. Moreover, the radiograph demonstrated an area of radiolucency (black shadow) just at the tip of the roots of the first molar. In other words, this indicated inflammation/infection.

The Assessment

Failing Root Canal of the Maxillary First Molar

The Plan

For that reason. I initiated antibiotics to keep area in “check” until I can get the patient back to Re-root canal the First Molar.

The Discussion

A root canal is a technically difficult procedure performed by a dentist. The process consists of two parts. First, the dentist mechanically removes infected biological material( nerve) utilizing very fine nickel titanium files from within tooth’s core. Second, the dentist packs inert material (gutta percha) to hermetically seal this evacuated space. In effect, the dentist removes the nerve of the tooth via a micro rotor-router approach and fills the emptied nerve chambers with rubber.

But Why Did That Previously Root Canal Treated Tooth Fail?

A previously root canal treated can fail creating that annoying discomfort for any number of reasons:

The most dominant reason of failure is due to insufficient irrigation by the operator in removing the infected biological debris from within the nerve chamber and canals. In short, bleach irrigation floats debris out of the shaped canal space. In essence, remaining debris can set up an environment for reinfection. In summary, every thing biological must come out from within the tooth.

On occasion, an Accessory Canal can be missed. Incidentally, canals are extremely small; the width of a human hair sometimes. Moreover, I use magnifying loupes in practice and I still miss identifying them, although rarely. By the way, the maxillary first molar has accessory canals 69.2 % of the time.

Sooner or later, an Improper fill can lead to a seepage of bacterial laced saliva back into tooth to reinfect. This is one reason why I strongly recommend to cover and ultimately seal your root canal treated tooth with a crown.

Generally speaking, a cracked root will lead to a failure of a previously treated root canal tooth. In a word, that’s a bad failure. In the final analysis, out comes the tooth and in goes the implant.

Above all, many retreatments can be successful. In reality, a failing root canal treated tooth can be resurrected with a little bit of patience and clever skill.

Below is another one of my many successful root canal treated cases in chronological order.

There is a large infection at this lateral central incisor( Black spot at root)

The Day of Completion of Root Canal Procedure -Day 1-

Three months out. Day -90-
Look and see how black spot at tip is fading away. That’s a good sign…..
One year out. Day 365- Healthy Bone fill has replaced the previously infected black spot

Credits:

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

A Late Night Emergency. Ouch! The Split tooth.

Almost Gone……..

Notes for the day written up, jacket on, briskly heading out and almost at the exit door last night. “Where you going? Didn’t you look at the schedule?” Natalie, pulled me aside and said, “wait, we got an emergency.”

Emergency Radiograph

Bicuspid Tooth. Upper Right. A two rooted tooth split down the middle
Clinically fractured tooth. Almost split in 1/2. Ouch!

First of all, the patient had no idea how it happened. Furthermore, it just hurt real bad. Sharp pain upper right side. An incessant throbbing pulse originating from a single tooth. It seemed like the radiograph revealed no decay, although there was a very small amalgam filling. Clinically, it was grotesquely obvious. I did not need my high powered eyeglasses. There was a rude fracture running front to back through the tooth. Subsequently, Dr Swanson and myself concluded that the tooth had to go.

Restorative Options

Unfortunately, an extraction was only treatment “option”. Likewise, restorative options were limited. The No tooth option was discussed. In contrast, the patient was reluctant to be toothless. The dread of a removable partial appliance was not desired either. For that reason, the only non removable options were either a bridge or an implant. Certainly the cemented “fixed” bridge option was discussed, but we’d have to section off and further extend a perfectly healthy, functional, existing bridge anterior to this hopeless tooth. It seemed obvious. Almost instantly we agreed. He said,”Let’s do what we did several years ago; another implant.”

Treatment

The Immediate Implant was opted

Surgical Removal of fractured Tooth

Above all, local anesthetic consisting of 2% Lidocaine was delivered by Dr. Swanson. Subsequently, I surgically removed the tooth in total in an uneventful manner.

This tooth was split all the way down to the trunk aspect. Very difficult to do.

The immediate Implant Placed

Hence, a (4.1 x 12mm) Straumann BLT Dental Implant was immediately placed by me in replacement/substitute of his hopeless tooth.

Bone Graft and Collagen Barrier Placed

In addition, I carefully grafted cadaver donated bone material to fill the remaining “empty space” ie, socket void. Finally, I like to layer a bio-resorbable collagen barrier over the graft to direct the maturation of the new gingival growth. This is called a Guided Bone Regeneration Technique (GBR). I really enjoyed demonstrating the nuance of this technique to Dr. Swanson. Dr Swanson is currently enrolled in a prestigious Implant training Program in Florida. In addition to working full time here at the practice, she’s a full time mom. Way To Go Collisha!

Implant Placed in lieu of removed fracture tooth
Grafted and Barrier in Place prior to closure
Implant Placed in it’s proper position in solid bone.

Conclusion and Analysis

Hence, 7:30 PM presented a perfect opportunity for an immediate implant. The tooth area was free from underlying infection due to the timing of the acute injury. This patient was a non smoker; therefore extremely healthy with no underlying metabolic disease. His bone quality and quantity was ideal.

The most obvious advantage of the immediate implant is my ability to preserve bone integrity and “fake the body out”. The seamless switching a natural root for a man made one(implant) is a nifty trick. We know that loss of a tooth cascades into an immediate and rapid dissolution of surrounding bone structure. Therefore, it’s imperative to replace a tooth immediately, when one can, to minimize future degenerative changes.

Actually, his timing couldn’t have been better, for an expected excellent outcome. It would seem that immediate access to me was critical. Certainly, it was the end of a long day. The thought making a positive impact in my patients’ life is what energized my enthusiasm to do the right thing. Emergencies, as such, are untimely. Rather, this is the nature of my job. It appears that I am always on call. Who would of thought? I am a dentist not a medical doctor? LOL. I love what I do and it seems that it really is not work when you are doing what you love to do any time of the day/night.

It would have been easy for me to dismiss the patient with a prescription and a reappointment. Time with the onset of the inevitable acute infection would have transpired within a short time if the tooth was not immediately extracted limiting our restorative options further. Most note worthy, we did what we had to do to get the job done. Consequently we ultimately provided a tremendous service to another great patient.

As a result, in 3 months, the implant will be restored by Dr.Swanson to function with a perfectly functional crown.

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your