Is this tooth saveable?

[Huz647]

So basically I've had an abscessed molar with a fistula for a long time. 2 days ago, my cheek started swelling like crazy and I was put on antibiotics. I went to the dentist today and they told me that my tooth is trying to drain from both sides. They told me that before this most recent issue, my chance of a successful root canal was 90%, now it's 30-40%. I think they're worried about bone loss. I honestly regret not taking care of this sooner. I don't want an extraction and implant, but I'm leaning towards the root canal and crown for one last shot of possibly saving the tooth. I'm having this work done at a dental school. What would you recommend? Am I delusional in thinking that I can save it?

 

[MattKW]

Didn't you post this on Reddit?I think you have a good chance for the RCT, but the big question will be the strength of the remaining tooth structure to be determined at the first appointment. Here's a similar before-and-after I did years ago

 

[Huz647]

Didn't you post this on Reddit?I think you have a good chance for the RCT, but the big question will be the strength of the remaining tooth structure to be determined at the first appointment. Here's a similar before-and-after I did years ago
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I just wanted to get as many opinions as possible, lol.

What's going on in those two pictures you posted?

 

[honestdoc]

I agree with Dr. MattKW in that the strength of the remaining tooth structure needs to be determined. There are some additional concerns. There may be external resorption at the end of the distal root (the root tip is getting eaten up) from the buccal (cheek side) and or lingual (tongue) side. I noticed the distal canal "disappearing at the apical third with some radiolucent shadow. Another concern is the long-term contamination in the internal anatomy that may be very difficult to disinfect especially over a mature biofilm. One species in the biofilm is E. Faecalis bacteria which is resistant to many disinfecting agents such as non full-strength bleach and calcium hydroxide. Hopefully in dental school, you will have an endodontic residency director to look after this case. I would assess this case as guarded prognosis depending on the strength of the final restoration, internal disinfection, and the canal seal.

 

[Huz647]

I agree with Dr. MattKW in that the strength of the remaining tooth structure needs to be determined. There are some additional concerns. There may be external resorption at the end of the distal root (the root tip is getting eaten up) from the buccal (cheek side) and or lingual (tongue) side. I noticed the distal canal "disappearing at the apical third with some radiolucent shadow. Another concern is the long-term contamination in the internal anatomy that may be very difficult to disinfect especially over a mature biofilm. One species in the biofilm is E. Faecalis bacteria which is resistant to many disinfecting agents such as non full-strength bleach and calcium hydroxide. Hopefully in dental school, you will have an endodontic residency director to look after this case. I would assess this case as guarded prognosis depending on the strength of the final restoration, internal disinfection, and the canal seal.

What would you put my odds at? Has there ever been a success story for anyone in my situation?

 

[MattKW]

I just wanted to get as many opinions as possible, lol.
What's going on in those two pictures you posted?

Sorry, forgot to label them. One of them is before I started the RCT and there is a lot of bone loss and infection around the root (darkness). In the other shot taken about a year afterwards, the bone has regrown to fill up the space. It's similar to your situation, and I put it up to show that the damage can be repaired. Too many people are writing off your tooth as a loss.

 

[Huz647]

Sorry, forgot to label them. One of them is before I started the RCT and there is a lot of bone loss and infection around the root (darkness). In the other shot taken about a year afterwards, the bone has regrown to fill up the space. It's similar to your situation, and I put it up to show that the damage can be repaired. Too many people are writing off your tooth as a loss.

No need to apologize. You're helping me out of the kindness of your heart. I'm very grateful for that.

Which factors does bone regrowth depend on? How long the infection has been there? Or is it random?

Hopefully it isn't a loss.

 

[MattKW]

It's a bit complicated and not always clear what the chances of some treatment will be. But from my years of experience, I'd happily give that tooth a go, and I think most endodontists (with even more experience) will agree. It doesn't always mean that the tooth has to be restored to mint condition, many times I have deviated from textbook ideals. But if it gives people another option, then it might suffice. Here's another case I did; honestdoc sounds as if he deals with people like this too who are desperate to save cruddy teeth. So the huge abscess has healed most of the way, even though the RCT is less than ideal, and the teeth are chunky blobs of composite. Not my best work, but it gave the patient some more years out of these teeth.

 

[honestdoc]

What would you put my odds at? Has there ever been a success story for anyone in my situation?

Odds are good if you are committed...no more "I honestly regret not taking care of this sooner." Best case scenario is having the graduate endodontic residency director complete the root canal. You may need multiple root canal visits to eradicate the mature contamination. Shortly after you need to have a solid core build up (Dr. MattKW likes a post on the distal root, I don't usually prefer one) and a crown. Root canals and crowns are expensive...remember the commitment.

 

[Huz647]

Odds are good if you are committed...no more "I honestly regret not taking care of this sooner." Best case scenario is having the graduate endodontic residency director complete the root canal. You may need multiple root canal visits to eradicate the mature contamination. Shortly after you need to have a solid core build up (Dr. MattKW likes a post on the distal root, I don't usually prefer one) and a crown. Root canals and crowns are expensive...remember the commitment.

Thank you very much.

I'll let you know how it goes

 

[Huz647]

It's a bit complicated and not always clear what the chances of some treatment will be. But from my years of experience, I'd happily give that tooth a go, and I think most endodontists (with even more experience) will agree. It doesn't always mean that the tooth has to be restored to mint condition, many times I have deviated from textbook ideals. But if it gives people another option, then it might suffice. Here's another case I did; honestdoc sounds as if he deals with people like this too who are desperate to save cruddy teeth. So the huge abscess has healed most of the way, even though the RCT is less than ideal, and the teeth are chunky blobs of composite. Not my best work, but it gave the patient some more years out of these teeth.
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Thank you very much.

I'll also let you know how it goes.