Case Report: Failing Root Canal Tooth

 

A long term patient came to my office with tooth pain yesterday. He complained that the tooth had woken him in the middle of the night and it took an hour to get comfortable after taking an over the counter analgesic. This patient had a root canal on this upper molar over 25 years ago, when he lived in the northeast. He saw a reputable specialist, but despite several visits, the endodontist (root canal specialist) could not get the tooth comfortable. So, an apicoectomy was performed on one of the roots (the mesiobuccal, which is the root on the outside toward the midline). At that time an amalgam filling was placed at the END of the root once it was surgically accessed through the bone.

 

At yesterday’s appointment, an x-ray was taken and compared to the most recent one from 4 years ago. I noticed a widening of the space at the end of the root where the surgery had been performed, plus there is a possibility that the largest root has a fracture on it. More importantly, I took a periodontal probe around the tooth and noticed that I could get a 10+ mm reading between the two roots on the outside. This is definitely not a good situation. The patient also commented that the measuring duplicated the pain he had that woke him up.

 

My recommendation to him is to visit the periodontist and see if anything can be done to salvage the tooth. I suspect he will more likely need a dental implant to replace this tooth. This patient also grinds his teeth rather significantly, so getting 25 years from a tooth in this condition is a pretty good result.