Question:
For a problem molar (upper 14) finally the endodontist advices me
to have surgery to remove the fractured root. It appears he sees
a shadow there. The surgery might solve the problem but there is
always the possibility it will not in which case out the molar
goes and in comes the implant or bridge etc.
Now to get to the root he will have to drill through the bone
from the interior of the mouth. The gum will be lifted and
he will gett to the root presumably by drilling
Wonderful. And what is happening to this hole how is it
going to close after?? Will I have a hole underneath the gum??
It all sounds awful. Granted this molar has been acting
for the past 3 and a half years (yes I did have a root canal)
and yet the abcess and the sensitivity comes and goes. This is
why the endodontist decided it is time to attempt to remove
this root
Answer:
I presume you have a skilled, honest endodontist.
It is sometimes extremely difficult to diagnose root fractures,
although their presence can sometimes be inferred by the area of bone
loss relative to the root, as well as presence of decay, large posts, or
specific problems related to the original root canal.
Don't worry too much about the root removal. The main problem
is access to the root without putting undue pressure on the other roots
to be retained. Pain should be no greater than a routine surgical
extraction.
Restoration of the tooth sometimes presents other problems.
Since the tooth has less bone support than it previously did, it is
sometimes necessary to splint (attach) it to an adjacent tooth (usually
by crowning both teeth and attaching the crowns together) for support.
The shape of the crown is sometimes also unusual, requiring a little
extra diligence with your oral hygiene.
I know of some dentists who don't like to save teeth with
amputated roots. One periodontist I refer to thinks these teeth always
fail eventually. But I've seen a high percentage of long-term
successes. If the situation is favorable, I think it is a very useful
procedure. And don't worry about the healing--the hole will close up
fairly quickly.
I understand that the dentist recommending the root amputation is the
second opinion dentist, not from the office that performed the root canal.
It is possible that a tooth with a root fracture could have occasional
flareups, between which are periods of relative quiescence. Usually, though,
if the fracture extends to the gumline it is unlikely that the infection will
totally disappear.
The dentist should have carefully probed the gumline with a
periodontal probe. Careful probing will sometimes find a deep periodontal
pocket extending down the length of the root fracture. Sometimes however you
can only identify the fracture after the gum has been flapped away from the
root, or even only after the root has been removed and carefully examined.
If there is a great deal of bone loss around one of the roots, it is
almost moot as to whether there is an actual fracture. Retaining a root with
that much bone loss will jeopardize the retention of the rest of the tooth.
And other things can cause the type of problem you are describing, such as an
unrecognized extra root canal (some of which may have been impossible to
treat, no matter how skilled the endodontist).
Do your best to check out the reputation of the dentist who will treat
you, and then do the procedure if he gives you a reasonable chance of
success. And this is a situation in which Murphy's Law holds sway--the tooth
will likely act up New Year's Eve, or when you're on vacation. The soreness
will only last a few days, and you've got plenty of time for complete healing.
