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.