Decay in tooth with root canal

funkey_monkey

As per the title. I have a lower front incisor which was detected today as having decay at the rear at the gumline and downwards.

The dentist told me that I will eventually lose my tooth which has left me devastated as I spent a lot of money a couple of years ago getting my teeth aligned with braces.

There was a hole that was detected as there was a small amount of hardened plaque on the back of the tooth along the gumline. Other than that I got a clean bill of health.

I'm really upset about this and I can't understand how it could happen. I've got a temporary filling and go back next week for an amalgam filling.

1. I missed my last 6 monthly appt due to being out of country for work. Would this have been able to save the tooth?
2. I have been using opalescence toothpaste mostly. Could this have been part of the cause?
3. What or why does the tooth stay you decay?

The hole was a reasonable size, but the dentist said the problem was mainly due to it being bake the gumline and because the tooth narrows as it goes towards the roots then any decay causes a greater effect.

I'm having to pay almost £350 for the treatment. The amalgam alone is £190. Is this a reasonable price?t The work is to be done in Belfast - I know some of you travel both for treatment so I thought I would ask.

I've been advised that I might need to get either a denture, Bridge or an implant. None of which interest me. All seem expensive and have drawbacks. I want my own tooth. Is there anything that can save it?

I've read that UCL have developed a way of regenerating dentine using a drug for alzheimers. It is planned to be out in 3 - 5 years.
Would this work for me or am I correct in thinking that it will not work on a tooth worth a root canal done?

How much pressure can these fillings take? I'm scared to eat anything other than bread at the minute.

EoghanIRL

Wishful thinking if you think you will be regrowing teeth any time soon!
These experiments are often in vitro in non human models.
I would imagine that this type of treatment is no where close to being available clinically, if at all.

btkm8unsl0w5r4

A professor of mine, who has some experiance in this area reckons this technology is at least 20 years off even humand trials.

Biug difference growing a bit of dentine in a petri dish. and getting a tooth to regrow in the right place, at the right time and then stop at the right time......

funkey_monkey

Dentist has looked at it again and thinks it is actually root absorption.
Tooth has to come out. I'm now going to be out a fortune to get a single tooth bridge and the associated work.
Gutted and just after getting my braces out just over a year ago.
Is this rare?

Dianthus

If you want, it might be worth arranging a consultation with a specialist endodontist.
They will be able to diagnose the type of resorption involved, & if it's at all possible to halt/treat it.

funkey_monkey

Does it matter if the tooth has a root canal treatment?
I was told that because it was the front lower incisor and the large hole was below the gumline that the tooth was at major risk of breaking.

The dentists were concerned about the ability to fill the hole - it took three attempts to get the hole fixed. Amalgam didn't work as there was insufficient tooth for it to latch onto. Ended up with a white type of temp filling.

Is the endodontist expensive?

Dianthus

A consultation would be around the €100 mark.
Endodontists specialise in root canal treatment,& tooth resorption defects.
The discussion & eventual outcome may be the same, but at least you know you'll have exhausted every avenue before having the tooth extracted.

funkey_monkey

Dianthus wrote: »

A consultation would be around the €100 mark.
Endodontists specialise in root canal treatment,& tooth resorption defects.
The discussion & eventual outcome may be the same, but at least you know you'll have exhausted every avenue before having the tooth extracted.

I've been quoted £600GBP - £700GBP for a single tooth bridge and £2,300GBP for an implant.
Considering that the tooth in question is LL1 (hence not overly visible unlike those on the upper arch) is there any point in even thinking about an implant here at this stage?

Is there any point if making the effort with an endodontist for an already RCT tooth with this problem?


Thanks.

Stheno

funkey_monkey wrote: »

I've been quoted £600GBP - £700GBP for a single tooth bridge and £2,300GBP for an implant.
Considering that the tooth in question is LL1 (hence not overly visible unlike those on the upper arch) is there any point in even thinking about an implant here at this stage?

Is there any point if making the effort with an endodontist for an already RCT tooth with this problem?


Thanks.

Are you saying the tooth has already been root canalled and is now at risk of complete breakdown?

funkey_monkey

Would my dentist be annoyed or irked if I asked about whether a referral to the endodontist would be apt?
(Although at the prices they are charging, I shouldn't really care whether they are offended or not).

Dianthus

funkey_monkey wrote: »

I've been advised that I might need to get either a denture, Bridge or an implant. None of which interest me. All seem expensive and have drawbacks. I want my own tooth. Is there anything that can save it? .

It's your tooth. Only you can decide what lengths and expense you want to go to, & who you choose to consult with in order to make a decision. Clinical& radiographic examination will always trump online posts though; you could write another A4 page worth of information, to no avail

funkey_monkey

Stheno wrote: »

Are you saying the tooth has already been root canalled and is now at risk of complete breakdown?

Yes.

funkey_monkey

Dianthus wrote: »

It's your tooth. Only you can decide what lengths and expense you want to go to, & who you choose to consult with in order to make a decision. Clinical& radiographic examination will always trump online posts though; you could write another A4 page worth of information, to no avail

Thanks - yes I appreciate this. Initially I really only posted in order to find out if I was being ripped off in terms of costs for the treaatment.
(And I'm still wondering if that is the case).

And to be fair, you've quoted from my initial post which was written prior to the dentist re-evaluating the prognosis to state that the tooth required removal.

funkey_monkey

Do implants last longer than bridges in general?  Is there any point in getting one over the other for a tooth that is partially hidden anyway behind the lower lip - not as prominent as the upper arch?

funkey_monkey

My dentist has just referred me to an endodontist as they are concerned about another tooth which is exhibiting similar signs to the extracted tooth, but at an earlier stage.

I guess this the risk with getting braces in adult life.

Gutted!

funkey_monkey

Good news is that the other tooth is fine.
Bad news is that he says I'e only got 5.5mm gap spacing which he is not sure would be enough for an implant. He ain't sure as it has been a number of years since he worked with implants.

Opinions - can I still get an implant with 5.5mm space?

helimachoptor

funkey_monkey wrote: »

Good news is that the other tooth is fine.
Bad news is that he says I'e only got 5.5mm gap spacing which he is not sure would be enough for an implant. He ain't sure as it has been a number of years since he worked with implants.

Opinions - can I still get an implant with 5.5mm space?

I would probably be looking to get an expert at this point..

funkey_monkey

Never ending misery.

funkey_monkey

Okay, so the saga continues.

I now need a bone graft as the wall of the socket at the front is too narrow.

Been advised to get a human bone graft as it would be better for my situation.

I've also been told that as the implant will be place low into the jaw, that a larger than normal amount of the tooth/cap will be exposed making it more obvious - although this is offset by it being on the lower jaw so will not be visible unless lip is pulled down to reveal it.

Another issue is that when the implant is in situ there will only be 1mm either side, but due to the jaw depth (I think) this should be okay.

So this would mean another 6 months minimum without a tooth. Plus the increase in cost for the graft. Plus the longer tooth/cap. Plus the +-1mm. Plus the next issue that arises.

Getting totally fed up with this now. Seems like this implant is turning into a complete money pit and disaster. At what point does this turn into unfeasible and a bridge becomes the best option?

btkm8unsl0w5r4

Get a nice resin bonded bridge, its a good option for a lower incisor. Sound like the implant site is far from ideal.

funkey_monkey

Going for a second opinion. I want an implant, but not sure about the site suitability.
Is there anything I should ask of the person giving me the second opinion?
Is it normal to be asking for a second opinion? Do dentists/Implant Specialists get this request often?

btkm8unsl0w5r4

funkey_monkey wrote: »

Going for a second opinion. I want an implant, but not sure about the site suitability.
Is there anything I should ask of the person giving me the second opinion?
Is it normal to be asking for a second opinion? Do dentists/Implant Specialists get this request often?

yes all very normal, ask simply for their opinion on your treatment options.

funkey_monkey

Got second opinion yesterday. Gap is narrow (~1mm) however it can be done with a tapered implant.
He recommends using my own bone for the graft - taken from my chin - not foreign body. He also mentioned that during the drilling process he gathers the debris from the drilling process and mixes it with my blood to use during the grafting process.
He also mentioned that he does slow speed drilling (~50rpm).

My original quote recommended human graft - but it was human graft from another person. I cannot remember if they said their implant would be tapered too. I can't remember the implant brand they use to check if they have tapered implants.

I think there is a difference in the guarantee provided as well. Original mentioned lifetime guarantee but the second opinion said 4 years. I'm not sure if they are both quoting for the same thing - i.e. product failure or insertion issues.

Second opinion is quoting £2,500, but that could rise slightly as there was no CT Scan available. Original quote is £3200. Really don't know how to jump on this one.

Any advice?

funkey_monkey

Not sure if it affects, but the original quote (£3200) was with Ankylos implants. Whereas the second opinion uses Straumann.

Any recommendations or opinions?

btkm8unsl0w5r4

So long as the implants is a reputable brands for which you can get components long into the future (both that you named are big long established brands) the implant system does not really matter. Dont focus on the nails focus on the person hammering them in, thats what matters.

Dianthus

100% agree; it's whose hands you're in that matters most, everything else will fall into place after that. The best practitioners use the best materials & want the best results possible; they don't & won't cut corners if they're perfectionists.
I wouldn't be getting too bogged down with drill speeds & shapes of implants - that's for the practitioner to worry about.

What you do need to know is:
-Their qualifications.... General dentist with a special interest? Periodontist? Prosthodontist? Oral Surgeon? Each will have their own skill set.
- Their experience with implants.... How many do they place weekly, monthly, yearly,& for how many years? Can they show you photos of their past work?
- The long-term maintenance plan....followup appointments/checkups, what guarantees are offered& are there any caveats.
- Limitations of treatment...cosmetic or otherwise

As a by the by, is the bridge option a complete non-runner?
Also, is it possible to post a photo of the area?

funkey_monkey

I'd prefer not to have a bridge.
I can take an image and post it. What type of image are you looking for? Will a frontal of the area suffice or are you looking for a dental xray - which I don't think I have - only xrays from when the tooth was still in place.

Is there any issues with using cow (or other human bone) over my own bone?

Dianthus

Just a standard photo taken from the front, with the lower lip retracted. Literally just to pad out the scenario.
Re pros& cons of bone grafts, I'm not a specialist so don't work with them personally hence can't advise, but again this should have been fully discussed during both your consultations. If it wasn't, you need to meet with them again. It's the whole point of meeting with them& paying them a consultation fee.
Your questions are all valid& relevant, I just don't understand how they haven't already been fully addressed as part of your consultations.

funkey_monkey

Okay, just one week out from my bone graft, the dentist has decided that the implant is not suitable and that I should go for a bridge.

Maryland bridge is what they are recommending with metal wings as opposed to porclein (as it chips over time).

What should I know about these things? How do they fare with biting into fruit, veg etc?

Fncked off :mad:

btkm8unsl0w5r4

funkey_monkey wrote: »

Okay, just one week out from my bone graft, the dentist has decided that the implant is not suitable and that I should go for a bridge.

Maryland bridge is what they are recommending with metal wings as opposed to porclein (as it chips over time).

What should I know about these things? How do they fare with biting into fruit, veg etc?

Fncked off :mad:

Post #20 three months ago above, you would swear I was some kind of dental savant...oh wait

I have had good success with Zirconia resin bonded bridges, Zirconia not longer has chipping issues if done to high quality and degassed properly in the lab, and you can get reasonable bonding with it with tribochemical treatment, you can also overcome the grey out of metal if you dentist is good. It all depends on hows its done not whats done. You will pay top dollar to have it done well as the dentists that do work at a high level well know the value of their work.

funkey_monkey

What price are you talking about? Is there a difference between Maryland and Resin bonded? How well do they stand up to biting forces etc?

I'm more annoyed that they led me on to believe that the implant was possible right up until I was coming in for the grafting process.

btkm8unsl0w5r4

the terms resin bonded bridge and a Maryland bridge are really used interchangeably, although technically there are some differences.

A nice resin bonded bridge and all the bits and bobs that go along with it could cost anywhere from 1000 euro to 3000 euro depending on who does it. It all depends on the level of result you want to achieve and quality of the service.

funkey_monkey

One final question!

What is the risk of debris becoming lodged underneath the bridge and leading inflammation etc.?

funkey_monkey

Would any of you recommend strongly either way in terms of either metal or ceramic/porclein fixings?

davo10

funkey_monkey wrote: »

Would any of you recommend strongly either way in terms of either metal or ceramic/porclein fixings?

The differences tend to be flexural strength (metal better), bonding and translucency of adjacent teeth. If your teeth are quite thin, the metal wings can give the adjacent teeth a greyish tint as you can see the wing through them.

funkey_monkey

They are quite thin as in when I press my tongue to the back of them the teeth darken.
Is there much of a price gap between the two option?

funkey_monkey

funkey_monkey wrote: »

They are quite thin as in when I press my tongue to the back of them the teeth darken.
Is there much of a price gap between the two option?

As this is for LL1 should I be looking at metal or ceramic wings? I am worried that metal wings will be visible and also tint the adjacent tint.
Having a call with dentist soon - would appreciate some advice on which is most appropriate for this region. They are offering metal as they say ceramic chip.

btkm8unsl0w5r4

Only your dentist who has seen your mouth can advise, best at this stage find a good dentist and trust they will do the correct job.

funkey_monkey

Well they have advised that I opt for a metal bridge as they bond better. The have also recommended a single wing as the current thinking is that there is increased flex with dual wings and they are more likely to de-bond.

It is contrary to how I would have thought about stability of the bridge, but I have to go with their opinion as they are the experts.

funkey_monkey

Tooth now in and wallet considerably lighter too
Looks good and happy with result minus the lack of being able to eat an apple and having to floss under thing.

Its been a long road to here.

funkey_monkey

Well its still in place. I've gone through a number of bite guards now since gettingt he braces removed so it looks like I'll need to upgrade to a Michigan splint which is more expense.
I think at this stage they recommended getting the worn teeth capped.

How strong are the caps? Do they need to grind down the tooth further in order to install a cap? I can see some (what I presume to be) dentyne visible on the worn down surface.

Dianthus

By "cap", do you mean composite build-up, or porcelain veneer/crown?
Either way, if you ground your natural teeth down, you'll do the exact same with composite or porcelain. The only barrier against bruxism(grinding) is a splint.
Consider seeing another dentist or prosthodontist if treatment plans aren't being communicated fully, and or if you want a second opinion.
Advice on Boards can only be given in general terms& won't be specific to your individual case.

funkey_monkey

They are going to provide me with a splint to prevent the grinding. £550.
I've also got the option of building up the worn down enamel. I'll need to double check the terminology used for the cap. It was mentioned almost a year ago now when I got the bridge in.

funkey_monkey

Anterior Composite Restoration (quartz alumino silicate) on both upper canines and lower incisor.

I was told that this was functional and not cosmetic, but I could manage without the restorations as the splint and upper biteguard would stabilise things.

Not sure which way to jump. Its a lot of money.

funkey_monkey

How long can be expected timewise from these restorations?

Dianthus

Your own dentist, or another dentist who has seen you clinically, would be best placed to advise.
Longevity of restorations is dependant on a tonne of factors- bite, jaw muscles, habits, enamel, number of teeth present, cause of tooth loss, oral hygiene, medical history, social history, diet, operator skill, ect ect.
It's a discussion for you& your dentist, as you'll be the only ones dealing with it.

funkey_monkey

I've been advised that they will last about 8 years. £600 for 8 years is a poor return.
Not sure what to do now.

Dianthus

Works out at about 21 cents a day.
Or less than €1.50 a week.
Your call as to what a good return is.

Oral Surgeon

funkey_monkey wrote: »

I've been advised that they will last about 8 years. £600 for 8 years is a poor return.
Not sure what to do now.

My wife gets her hair done every 6-8 weeks at a cost of about €150... Everything has a price and a lifespan, it's up to you if it makes sense to you or not....