Are my root canals done correctly? Pls advise.

[Vandy]

Please see attached xrays. The first xray is from before the root canal treatments (on the day of the RCT) and the second x-ray is from during and after the RCTs. I need an opinion if my RCTs on my two teeth (lower right side 6 and 7) have been done correctly or not. They were done a little over a month back. I am having pain upon chewing/pressing down on those two teeth. Before the RCTs, there was never any such pain while chewing or pressing down on those two teeth. (The RCTs had to be done due to pulpitis, not infection.)

It seems the pain is more in tooth #6 (only when pressing down on it, not otherwise). Tooth #7 also has slight pain while pressing down on it, but it's less than #6. Have the canals in both teeth (and especially #6) been instrumented and filled all the way to the apex or not? Because when I look at the xray, it seems the gutta percha isn't going all the way to the tip. But when he was preparing the canals, his apex machine was beeping whenever he reached the tips, and he said to me that he reached the apex. He told me that the canals were calcified so he had to use a new file.

Actually I had requested him during the last sitting NOT to put the gutta percha yet as I still had pain upon chewing (in case I wanted to get it rechecked), but he insisted to do it, saying it was necessary for healing. He said he put a bioceramic sealant along with the gutta percha.

The pain is only while pressing down on the teeth, not otherwise.

Pls let me know, after seeing the x-rays, if anything seems wrong with the RCTs in both teeth, if the gutta percha is all the way to the tip/apex or not, what could be the reason for the pain, and anything else you observe, and what I should do now?

 

[Dr M]

Do you perhaps have x-rays after the treatment has been completed? It is important to note, there is a difference between the anatomical and radiological apex. This is why we use an apex locator. This sometimes means that the anatomical apex, is shorter than what the root appears on the x-ray.
This does not mean it is short filled.
Pain on biting might also be an indication that the filling is too high. I would suggest checking your occlusion and perhaps adjust the filling.
After a root canal, it takes some time to settle. This can take 3 or sometimes even 6 months.

 

[Vandy]

He sent me that second x-ray which I uploaded, after saying that he has completed the root canal treatment with gutta percha filling and bioceramic sealant, and he said that now all that is left to be done is only the composite fillings at the top of the teeth (right now both teeth have temp fillings). He has only shared with me the above two xrays which I uploaded. The second image is from the last sitting. That xray image has another xray image within it. The larger image is of the instrumentation of #6, and the smaller image (within that image) is after he sealed both #6 and #7 with gutta percha in the last sitting. I have separated and uploaded those images again below. I have not visited him after that last sitting. I wanted to get an opinion about his gutta percha filling first, because it seems that the gutta percha is not filled to the point where his instrumentation had previously reached. If so, could this be a reason for the pain upon pressing/chewing? I can't chew on that side at all, because although it doesn't hurt otherwise, but if I do continue to chew even slightly on it, then the pain will increase n then remain continuously for days, then subside again. Even if I press slightly on the teeth just with my tongue, they hurt. The pain is like when you press on a wound, it hurts. In #6, the pain seems more in the middle of the tooth.

 

[Dr M]

It could be that it is short filled when compared to the initial instrumentation x-ray. I would suggest going back to the dentist to start. Explain your concerns and symptoms. Check that the temporary filling is not interfering with your bite. Sometimes it might be necessary to prescribe medication as well. I don't know if he did initially?
If this does not relief the pain, the RCT needs to be re-done, and instrumented even further, to see if the GP can reach further down.

 

[Vandy]

Yes, medicines were prescribed initially. I have yet to see the doctor again, as he was out of town. I wanted to ask you about another symptom I had. About 5 days after the canals were instrumented, there was a really bad foul smell, not in my mouth, but in my sinuses. And I am not sure how to describe the smell, but it was somewhat like of rotting flesh (or maybe like the smell of a blood clot.. or of a tooth socket a few days after tooth extraction). The smell lasted for 2 days n then disappeared. The smell reappeared 3 days ago n lasted for 2 days again. This kind of smell has never occurred in any of my previous root canals. There is no swelling at all. what could be the cause?

Could there be debris at the bottom of the root canaled teeth which could be the cause of both the pain and the smell? Because he said they were calcified and was drilling a lot, so could it be that the debris got pushed below the apex and when I bite down on it, the debris causes pain? Because the pain is only upon pressing the tooth/chewing and not otherwise. (So I don't chew on it, else the pain will get aggravated n then it will last for days) if debris is there, how will he be able to get the debris out now? Is there anything I should tell him to keep in mind?

The pain is not due to any swelling. It feels like something is being pressed.

I did speak to the doctor over the phone and told him about the short fill, n he said he will redo it. I m not sure if he will redo both or only #6. Is #7 short filled too? I hope, while removing, the sealant n gutta percha doesn't get extruded out of the apex.

Is there any other possible cause for the pain?

As there was a 3 week gap between the instrumentation /preparation of the canals and the filling of gutta percha, could it be possible that the canals got recalcified during that period? And could it be that's why the gutta percha couldn't go to the apex, because it got blocked again? And that his previous canal length measurements got messed up due to recalcification of the canals?