Fistula after retreatment of molar. Root cracked? Do I need an implant?
Question from Anonymous:
I had a root canal retreatment on tooth #3. About 2-3 weeks after that, a bump developed on the gum above the treated tooth (there was no bump pre-op). The endodontist suspects the MB root is cracked and suggests root amputation. But he
said there is chance it is not cracked and only apicoectomy will be needed.
There is deep pocket on the gum in question, therefore my dentist said a crack
is very likely. Please see the radiography attached. (I also wonder if the RC
retreatment was too aggressive since the roots became much wider than pre-op,
and as the result the RC retreatment caused the crack?)
I will try to give you my opinion, but I hope that you ask all these questions to your treating dentist which has the advantage of clinical information obtained by examining you in person.
I cannot see very much detail in the xrays you sent, other than the canals being enlarged a lot, which sometimes is necessary, but tends to weaken the tooth more.
If the tooth also has a deep pocket, you can have a successful endodontic treatment and still the molar could have periodontally related problems in the future, so it depends on whether you want to save the tooth realizing it may not last long term, or you want a strong restoration with good long term prognosis.
The bone graft is also highly indicated in your situation after an extraction because the holes left by the 3 roots of the molar would not allow easy placement of an implant at the time of the extraction.
Hope this helps.
Carlos Boudet, DDS, DICOI