Monday, September 29, 2008

Root Perforation causing Tooth Loss

This patient came to our office for evaluation of tooth #3. He reported having a recent root canal and crown done by a general dentist. Since the time the work was completed, he was experiencing "burning & itching in the gums around that tooth". The patient was concerned that he was having an allergic reaction to the cement or materials of the crown.

Our examination found #3 sensitive to palpation, moderately sensitive to percussion. (Adjacent teeth WNL) The radiopacent material in the furcation area of the tooth was noted.

Retreatment was initiated to evaluate the area.

The crown was first removed. Upon first look, there appears to be mesial decay still present and an obvious void between the tooth and the post/core material.

Additional removal of the buildup material shows a surprise underneath.

It become obvious that the distal wall of the MB canal has been perforated.

At this point, we can understand where the symptoms have been coming from. An attempt could be made to try and repair this defect (with MTA), however, the long term prognosis would be guarded to poor. Considering the the cost of initial treatment, the cost of retreatment which would then require post & build-up and new crown, this patient elected to extract the tooth.

This then becomes an appropriate time to replace this missing tooth with an implant or bridge. I recommended an implant consultation.

Endodontic treatment did not fail on this patient. The treating doctor failed to put his patient's best interest first and failed to inform the patient of the treatment complication (perforation) that occurred during treatment.

In a case like this, the patient referred himself to our office for evaluation. Had his dentist properly evaluated the case difficulty and referred him to an endodontist for treatment, this tooth would likely not have been lost.

This is not endodontic failure. This is failure to do good endodontics. This failure to do quality endodontics may be part of the reason that some clinicians are questioning the success of endodontic treatment.


Anonymous said...

Very infromative!

Toms River Dentist

Anonymous said...

People need to use due diligence when it comes to anything health related. They will spent more time buying a car than they would in finding good dentist.

Leto d-.-b said...

I appreciate a lot your blog. You have very interesting cases posted. I just would like to make you a suggestion:

I'm studing dentistry at UNMSM in Lima, PerĂº. I speak/read/talk a bit of english, but I cannot understand the "acronyms" you use (e.g. WNL). Could you please use the acronyms after mentioning the entire frase once in the post? Thanks a LOT.

Julio Reyna.

Richmond Hill dentist said...

A dentist must understand his/her limits and when to refer. Unfortunately for this patient, the general dentist did not and tooth loss was the result.

Holistic Dental – Cosmetic Dentist Melbourne said...

Nice Work done!!!

Throughout the course of life, teeth are lost for many reasons,including cavities, gum disease, cracked roots and accidents.When a tooth is lost the bone that previously supported that tooth starts to res-orb away. Missing teeth can compromise your eating habits, speech and appearance.

Keep posting such good articles.

Dentist Melbourne

Anonymous said...

as a patient of an endodontist who caused a perforation, what if any recourse do i have in resolving the following situation?

the endodontist didn't tell me about the perforation - but my general dentist noticed it very quickly at the time of my crown appointment. he actually wouldn't put the crown on because in order to avoid future infection i now have to go back to my endodontist to have the perforation repaired first. did the endodontist do anything wrong? is there any recourse i could pursue?

The Endo Blog said...


I'm sorry to hear about the challenge you are having with your tooth. I am glad that you are seeing an endodontist. I would simply recommend discussing this issue with your endodontist. Root perforations occur. They happen to anyone who is performing root canal therapy. Your endodontist is the best person to manage that root perforation. He has likely repaired it with MTA and you should have proper follow up with him over time. Many root perforations are successfully repaired with MTA and not an issue. You should make sure that your endodontist has properly treated the perforation and get on a recall schedule to evaluated it.
In short, just have a discussion with your endodontist.