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Posted by David on June 14, 2000 at 23:02:11:

In Reply to: Re: Apicoectomy Nightmare - David, just a couple more questions posted by Mary on June 14, 2000 at 18:01:04:

: David,

: Thank you for replying to my message regarding my Apicoectomy Nightmare. You know so much about dentistry and I really appreciate your two-cents. I have a couple more questions for you if you have the time (I see your name on the Message Board a lot so I know youíre pretty busy).

: First, in answer to some of your thoughts as to what might be wrong:

: 1) Every now and then I catch myself clenching my teeth but quickly relax my bite. This doesnít happen very often and I donít have much stress in my life except for my teeth.

: 2) I already had my sinuses checked out by one of the top ENT doctors - no infection. I even had a CAT scan of the sinuses which were normal. The MRI was for the brain and amazingly enough that was ďnormal.Ē

: 3) When the crown was replaced because of a chip, I donít think the dowel pin was replaced.

: 4) Currently I have a temporary crown on #13 & #12. The dentist made up a bridge for #12 and #13 with a tooth attached to the back of #13 to take the place of #14. I have no idea how that tooth was supposed to stay up. I thought I was only going to get separate crowns not a bridge. I refused delivery because of the pain in #13 Ė I didnít want to end up having that removed!

: So I can be better prepared when I get another evaluation, I just have a few more questions.

: 1) How can it be determined if a tooth is cracked?
: 2) Is it possible to have a 2nd Apico? What are the chances of it working?
: 3) If #13 cannot be saved and has to be pulled, can bone be built up somehow so that I could get implants? (I donít have any teeth behind #13)
: 4)You mentioned that implants carry risks Ė what are they?

: Thank you for your help.

: Mary
It would not be possible to answer all of your questions, and it probably
isn't my position to do that, afterall, your doctors should be answering these
questions. But, since you asked:
1. Cracked teeth present with many symptoms, but in your case, since
RCT (root canal therapy) has been done, you'd look for small hairline fractures
on the internal aspect of the tooth. They are hard to spot, so the unobservant
dentist might glance right over them. Also, if the bone around the tooth has
any dark circles, or a "blown-out" PDL (periodontal ligament) space, that
would indicate a crack also. As a rudimentary test, one that you could do,
take the end of a BIC pen (plastic cap) and bite on different locations on
tooth #13. If you can repeat an area with definitive pain, you probably have
a cracked tooth.
2. A second apico? Yes that might work, but how do you know the second
doctor is any better than the first? In addition, did you know that cutting the
gum tissue and cheek can leave you with diminished sensation. Your face
won't be drooping or anything that bad, but you might notice a difference. Ask
about that. If the doctor can present a really good argument for retreatment
at this early time, then you might consider the second apico.
3. If #13 is lost the area most likely could be fixed to accept an implant, unless
the sinus drops down low, then you'd need sinus surgery (augmentation) to fix
4. Implants can fail, and when they do, watch out! Infections, poor wound
healing, improper mechanics (after crowns are placed), sinus perforations,
excessive heat generated when drilling into the bone, etc. can all cause
problems. Mostly the success rate is good on the surgery, maybe 90-95%,
but the most problems come up when restoring them. Mechanics is a big
problem, since implants don't act like natural teeth, yet patients treat them
as if they do.
5. If you catch yourself clenching during the day, I'll bet you clench your teeth
at night while you sleep. You may need a nightguard, which is just about
mandatory when you have implants.
6. Sounds like the dentist already started a cantilever bridge in your mouth.
That type of bridge on already weak teeth could spell disaster, and the dentist
probably isn't looking at the mechanics of the case. Go to the library and
look up cantilever bridge, then try to find a picture of this type of engineering
used to put a bridge over water (with regards to a road). You won't find it,
since the abutments take a pounding, and eventually fail.

You ask good questions, but don't ask me, ask your doctors.

Hey, good luck.

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