I've has a low grade infection /abcess above a root canal filled upper molar for 1.5 years. Over that time: 1) my dentist root canaled an adjacent tooth looking for a sympathetic cause with no result; 2) referred me to an endontist who wanted to redo the old root canal but as a practice only removed the old crown first (so I went for a second opinion); 3) the second endontist did drill through the crown and found some infection and temporarily filled it; 4) returned three months later and the infection had subsided somewhat but he did it again and said to return in four months; 4) I returned with the infection continuing so he said there was some probability of a fracture which he couldn't see in the x-ray; 5) So I went and had a full jaw x-ray and went to a myofacial surgeon for advice and this is where my confusion lies.

He was very polite but I found him to be so negative in all of the options he presented each of which potentially would cost significant dollars. Without any examination other than the x-ray I supplied, he started off talking about a nearby impacted wisdom tooth that is being resorbed by the body and before I had been listening to him for three minutes he mentioned the possibility of losing the three adjacent teeth. When I expressed concern about the haste and direction of discussion, he did start talking about the tooth concerned. He said that he thought there was a fracture and said that there was a less than 50% chance of success with surgery that would simply remove the infected tissue and snip off the end of the root nearby. He also said that he thought one of the other roots went into the sinus wall and was very negative about extracting the tooth which he said could come to pieces and create a large hole in the sinus wall and require special work there with the prognosis there uncertain. He also thought the bone that was receeding around the roots might limit the success of any implant. Also that any bridge/denture might not be able to be done because of the potential loss of the tooth next to the impacted wisdom tooth.

After all this he said that we could just cut it open and take a look without any idea of what's coming. Meanwhile there is only minor discomfort.

Is there anyone else who might be a little confused by this or can share any experiences which might give me some ideas on how to proceed. I feel a bit shy about getting second opinions here because all of these specialists seem to know each other and I wonder if they might be reluctnat to contradict each other. Its the barrage of negative options discussed without any certainty about any of them. I think if you look for a problem then you will find one sometimes. Are there any other alternatives? Any feedback is welcome.

Well, everything the oral surgeon is very very possible. 1st, the wisdom tooth: Resorption of wisdom teeth isn't uncommon. Resorption is caused by an immune response and if the wisdom tooth is left in, the resorption will probably (though not definately) continue and spread to the other teeth, causing you to lose them. Teeth with resorption are notoriously hard to save. But pulling the wisdom tooth should stop the progression of the resorption and give your other teeth a better fighting chance.
Now the other tooth... I think it is very possible for it to be fractured and causing you to have the continued infection problems. Unfortunately, some fractures are not easily seen on x-rays at all, therefore only deductive reasoning can diagnose some fractures. If the tooth (or root) is fractured, you will probably lose it, unfortunately. BUT, the continued infection could be caused by other things, and the apico may be the way to go (retreatment and removing the root). Then hopefully the infection will be cleared out and the tooth can be crowned and you can go on with your life. If you do end up losing the tooth, it would not suprise me that you have some bone ressesscion because of the long infection you have had. After the tooth is removed, hopefully you will have good bone regeneration and it will heal to the point that you can have an implant put in (I would consider this over a bridge, particularly if you don't want to have the wisdom tooth removed). With molars and their long roots, sinus involvement is a problem, and if you do indeed have this problem, you will need to have a "sinus lift" which isn't terribly bad, though a pain in the rump! At that time, if need be, you could have the bone graphs needed for an implant.

OK, enough rambling. If I were you, I would have the wisdom tooth removed and the root canaled tooth either extracted or an apico. Retreatment maybe wouldn't be a bad first step as it is the least invasive. Then, in a few months, you will know what the root canaled tooth is going to do and either it will be fine, or you should just extract it. Also, you will be able to know if the resorption has stopped or not. If it has, then great and you can have a bridge or implant, whichever you prefer. BUT, as retreatment and the apico is the least risky and is the least invasive, I don't think it would be a bad place to start - and I really would consider having the wisdom tooth just removed at the same time.

Good luck with all of this - I want to know what happens!

Thank you for that thoughtful reply

hi..
I just had my last back molar extracted due to an abcess/infection that was going on in it for years...I didnt want to go thru the whole root canal thing, since the infection was present for so long, and he said it looked like some bone loss was present on the xrays..It was my tooth right next to an iimpacted wisdom tooth...The oral surgeon said with this tooth removed, the impacted wisdom tooth may even drop down in that space eventually, and I would not need an implant or anything..I feel much better overall with the tooth extracted... :angel: