Is this ever considered alright?

[RootandFive]

I had a bit of an epic dental gong show, I won't bother going into all the details unless anyone really wants to know... It was basically an issue with a root canal that got really out of hand (as in I was told I didn't have a dental problem in 3 visits to dental offices but after being tested for things like kidney and thyroid problems it turns out it was a dental problem) Through a complaints process I found out there was a claim that a PA X-ray of the tooth in question during my first appointment that I tried to tell this dentist that there was something wrong with this root canal, one month exactly after the root canal was done, I knew this X-ray hadn't been taken because I remember leaving that appointment feeling like it was pointless because they weren't even looking for a problem. I got my records through the complaint process (with no X-rays) and the record for that appointment says there was a PA X-ray taken that was compared to the post op X-ray from the month earlier. I asked for my X-rays from the dentist and after a bit of a run around I received poor quality photocopies which didn't include this X-ray but did include what to me what to me looked like a second copy of the post op X-ray with no date. I asked the dentist about this and never received a response. My complaint was closed with no regulatory criticism of the dentist, through the review process I was able to see all the complaint investigation records and the complaint investigator asked for the PA X-ray in question and received the post op X-ray with the date changed, they recognized this and asked for the correct one at which point the receptionist said there must have been a typo because there was no X-ray on this date. The review process also closed with no criticism of the investigation...

I'm floored... I come from an aviation maintenance background and if I had changed a date on a record and submitted this to my regulating authority I would have been in a massive heap of trouble... I was curious if this is acceptable to dentists anywhere?!

 

[Busybee]

Hi, it's not acceptable for any dentist to tamper with your records. But I don't know what country you are in or the laws there.

Is your tooth and health ok now?

 

[RootandFive]

Thanks for asking Busybee! Health is fine now other than I'm still missing the tooth, it was extracted, since had a sinus surgery to clean out what the dental infection left there (there was an 18mm cyst around the roots of this tooth in my sinus), then a graft to deal with the scar tissue from the sinus surgery, then a dental implant that failed and had to be removed about four months after I got the crown (implant was totally loose and came out with the healing abutment, which had been put back on after two months with the crown that I could never put pressure on) I still also have the ringing in my left ear that started around two months after the root canal but I'm just learning to deal with it... I dealt with tons of headaches which took a long time (well over a year) to get back to normal and I did 9 rounds of antibiotics in 2016, it took a heck of a long time (and a ton of probiotics and antacids) for my stomach to get back to normal...

It's just been an incredibly frustrating process because I feel like there's some lessons to be learned to prevent this type thing from happening again (the dentist is very experienced) but it seems like the process in place is only interested in sweeping everything under the rug.

 

[Busybee]

Did the same dentist do the implant?

 

[RootandFive]

Nope, Periodontist did the implant, I have no complaint with them, they were actually a ton of help, I saw them for a consultation about replacing the tooth but they were the one to actually inform me about the problem in my sinus and talked with my doctor and helped get things moving in the right direction to get the infection cleared up. I know they took a very cautious attempt at the implant as not to do any more damage to my sinus but I can't help but wonder if that infection being there for as long as it was damaged the bone..

 

[Busybee]

Ok, it's funny but sometimes the professionals who you feel have done the best job because they have a good attitude, haven't really done as well as you think. A perio is for gums and should have referred you for an implant. You could try an implant specialist to see if they can help replace the tooth. Periodontists should stick to their specialty.

 

[RootandFive]

The periodontist's site says they're also a specialist in implant surgery and holds a master's degree in Craniofacial Science with a thesis on the stability of dental implants, so probably qualified... the implant failed but they didn't ever refuse to help me, they didn't leave me sick for months with what turned out to be a dental infection like the dentist (who was an endodontist) that did the root canal and then diagnosed there was no problem with an X-ray that was never taken... the Periodontist also fixed up my cheek because the scar tissue from the sinus surgery made my cheek feel tight and I could feel it all the time... The Periodontist's conversation with my doctor got me to an ENT dr. months sooner, so yeh, it sucks my implant failed but I think that has more to do with the endodontist's actions than the periodontist's..

 

[Busybee]

So the endodontist, was that the dentist that you first saw? Was that a specialist?

 

[RootandFive]

Yeh, well, a general dentist referred me to the endodontist that did the root canal, they're the one that said they took the X-ray that was never taken. It seem like my complaint investigator, another very experienced dentist, was more interested in covering the endodontist's mistake than anything else and it's made fair treatment pretty much impossible. (this was a tooth that couldn't be frozen at all during the first attempt but was then done in one appointment after a week on antibiotics, from what I've learned since it shouldn't be entirely surprising that it was still giving me problems or that this infection ended up in my sinus)

 

[Busybee]

So why did you go to a periodontist for an implant?

 

[RootandFive]

It was a referral, they're a periodontist that also specialised in implants.

 

[Busybee]

You've certainly had an awful time of it, but I am glad you are feeling a lot better now. You could try to take it further legally depending on the laws of your country, perhaps a legal expert in negligence claims could help you find a different angle to pursue a case. This is why I always advise people to get a second opinion when they have a dental problem. It seems you were not a good candidate for an implant which is why I was asking who did it. Are you able to get a bridge?

 

[RootandFive]

Just curious, why would you say I wasn't a good candidate for an implant? I was informed it wasn't optimal because of the history of infection so I don't think I was given unrealistic expectations but I don't think this periodontist would have gone forward if they hadn't been reasonably confident it would have been successful. This gong show was more complicated that I've bothered explaining but I had the root canal in Jan.2016, got a second opinion Apr.1st, 2016, (was offered a retreatment by a second endodontist with 50% chance of success but wasn't told about what was going on in my sinus) had the tooth pulled Apr.4th, started feeling better within the next week then started feeling sick again three weeks later, saw the periodontist late May, had them look at the apr.1 dental CT which is when I was told there was the cyst... Made it to the ENT who sent me to an oral surgeon who cleaned out my sinus mid june...

Had the implant placed in the end of Oct.2016, they did a sinus bump instead of a sinus lift because they didn't want to risk more damage to my sinus or access it a second time through that bone in my cheek, so it was a 6mm implant (tooth 26) but apparently it was a very highend implant that they thought was going to do the trick. Apparently is looked totally integrated and I got the crown in late May 2017 but I couldn't put pressure on it from day 1, after two months I had the crown removed and the healing cap put on because I was only chewing on one side and that was causing more jaw problems (which seems to be what started the tinnitus too) The plan was to wait and see, I was also scheduled for an MRI because of the headaches and tinnitus. then in Sept.2017 I noticed the healing cap seemed loose only it wasn't the healing cap, it was the entire implant. There was no infection when it failed, it just wasn't fused to the bone at all anymore, when it came out the periodontist noted that they could see the thread marks in the bone still if that means anything?

It has now been recommended I get a bridge... which I have to pay for from scratch after already having paid out $5700 beyond what my insurance covered... I'm hesitant to have this gong show include two teeth that have never given me any trouble (one of which is my only other root canaled tooth with a crown). I'm nervous that if I get a bridge and have any issues with it it'll be like this misadventure never ended and I'm mad as hell but more about how I was treated through the complaints process than the dental end of this...

I've seen the ENT Dr. again and he didn't have concerns of problems if I were to get a sinus lift and try an implant again though the Periodontist doesn't think I should try again... I'm just curious how time with no tooth there effects the bone? Would another attempt be even less likely to succeed or would more time to heal improve chances? To me I'd rather pay more now and not mess with two problem free teeth but obviously I won't if it doesn't look like a good idea... (Again I should say, this periodontist has been a huge help, even if that implant failed, I got sick a third time after all this, and it felt just like when I got sick again after the tooth came out only this time it was a mother strep throat with oral thrush bad enough that the skin got all blistered around my mouth... I think I'd basically beaten the living crap out of my immune system over the last year and for the first time ever was dealing with a real anxiety issue around infection and this periodontist spent extra time and effort with me (and was willing to personally e-mail with me) to answer questions and help convince me that this dental infection was 100% gone...

I'm still working on getting resolution for this, basically the legal end of things was impossible (I'm in Canada, my complaint was closed the day before the dentist involved became a board member of this province's regulatory authority... So basically I have to have an opinion that the standard of care wasn't met from a dentist who would have to be speaking out against a member of the board of their own regulating authority.... good luck with that one huh?)

 

[Busybee]

Just curious, why would you say I wasn't a good candidate for an implant?

Purely what you've posted about having a long standing infection and then damage to your sinus area. They told you that you were not optimal so it's surprising they went ahead. I'm not a dentist but the way you have described it you didn't have a good foundation for an implant. The longer you have an untreated infection the greater the chance of bone loss. How do you feel without a tooth there?

 

[MattKW]

The periodontist's site says they're also a specialist in implant surgery ...

Yes, there is no defined specialty role for implants. Periodontists often do the implant placement because they are experienced in tissue management.

 

[RootandFive]

In response to the post that is no longer here;

This is the photocopy I received when I asked for my X-rays, this is the post op X-ray;

There's a claim there was a PA X-ray taken Feb.19th when I went back saying there was something wrong which I knew hadn't been taken but I received this without a date; (looks familiar?) (by the way, I didn't have a temporary crown by Feb.19th)

I went back again on Mar.9 trying to get help and was told it wasn't a dental problem and the only help I was offered was that "there's always the emergency room" I was shown this X-ray to prove I didn't have a dental problem causing my sinus issues; (and yes, that date is wrong)

These are screen shots from Apr.1st when I went for a second opinion (my sinus had been clear on all my X-rays prior to this root canal)

I had enough as I'd been feeling slowly sicker and sicker since late February, I had what I think is a panic attack (my first and only one I've ever had, I'm sure it was due to pure exhaustion) Apr.3rd and being that I was given a 50/50 shot of successful retreatment, which I was booked for on the 13th, I had the tooth pulled on the 4th.

I started feeling better for a bit and started feeling sick again three weeks later, this is my May.31st medical CT scan. I hadn't been told by the second endodontist that there was any issue with my sinus, nor was there any mention of it in his info to the referring general dentist I went to for the second opinion. I ended up having a sinus surgery in June.

This is the extracted tooth, the left root was opened up by the dentist who did the extraction because he thought there might be a file in there which wasn't the case, it was just a blue filler, the root on the right has to canals with fillers visible, I was told this had nothing to do with my issues by my complaint investigator but I don't believe this one bit anymore.

 

[MattKW]

In the X-rays, all root canals appear to be well done in the first molar and premolar. Just because you had a cyst doesn't mean it was of dental origin; in fact, they are quite rare. On OPG X-rays I often see cysts in the maxillary sinuses. These are assumed to be mucous retention cysts (MRCs), and require no treatment unless the patient is having sinus problems (go Google them). I simply point them out to patients and ask if they're having any issues. Most stay unchanged, some get slightly larger, and some shrink away to nothing. I strongly doubt that your cyst was of dental origin, and it may be that the tooth was extracted unnecessarily, sorry .
The removal of the cyst should not caused any damage to the bone in the area of the implant because the surgeons wouldn't access through that region. However, the extraction of the molar would have caused some bone loss.
The "quality" of an implant is only a small factor in the success or failure. The most important factors are probably the density (quality) of the bone, and the size of the implant. Both of these factors were less than ideal in your situation. It doesn't matter much about the supposed quality of the implant itself. A sinus lift doesn't really make things much better, so I can understand why the periodontist is shying away from this again.
The risk entailed with a bridge here come from the root-filled premolar. Using root-filled teeth for bridge abutments is risky. At the very least you would need to reinforce the premolar with a cast post and core. An alternative is to extract the premolar(!), then place an implant in this space, then bridge that to the 2nd molar. I'd seek the advice of a prosthodontist.

 

[RootandFive]

I guess the 'good' thing is that I don't feel that tooth was not the cause of my problems and extracted for no reason. the reasons I'm convinced the cyst was dental related are as follows:

-black/clear sinus on PA X-rays up until the root canal
-started having sinus issues shortly after the Jan.19 root canal that slowly got worse
-Mar.2nd PA X-ray of that tooth had cloudy sinus and it had a sensitivity to percussion by the original referring dentist who told me to go talk to the endodontist again.
-2nd Endodontist, though not explaining the sinus issue said that my 26 tooth was causing a chronic infection that was responsible for my symptoms, both him and the referring general dentist found a sensitivity to percussion that I didn't have before the root canal.
-blood tests kept on getting slowly further out of the normal range, white count kept going up
-when I started feeling sick again after the tooth had come out the spot where the tooth had come out became incredible sensitive to any sort of jarring motion like stepping down too hard, this went away after a couple days on another round of antibiotics
-Periodontist's records says the cyst was from the dental infection,
-ENT records explained way he didn't think it was a mucous retention cyst and sent me to the oral surgeon because it was dental related.
-Oral surgeon who cleaned out my sinus said there had definitely been a sinus communication
-I kept my original ENT appointment with the only ENT Dr. in my town which was months after I had seen a different ENT that could see me sooner because my ear hasn't stopped ringing, he also thought my sinus problems were related to my 26 tooth.
-I've never seen a doctor for sinus issues in the 36 years before this gong show or the two years since I had that sinus surgery...