Maxillary sinus and some teeth

[thomr]

Hello!
I have some trouble with some teeth. I attached an xray, well two actually, one was made in 2013 and the second in 2018. Top is 2018, bottom is 2013. Here is the link https://imgur.com/a/BURQGUU
Why am i posting? Well my dentist thought that there might be something there, right side, that obvious maxilary sinus thing, first i had an xray done for C16, then he asked for the full scan. He then asked a person that is a surgeon if there might be something there, and he said that's just the way the maxilary sinus is.
More info:
C16 had it's nerve removed and filled, as this is the main reason i went to the dentists, i sometimes had discomfort there, and decided to have it checked. This was in february. Last week i had a new pain, this time sharp and 10/10, i believed that it was the same tooth, but after checking with the dentist it seems that it was C14.
More info:
The pain from C14 was very sharp and it went away in ~10seconds if cold water was applied, and it went straight to 10 in 5 seconds if hot water was applied (coffee,soup etc), that's how he tested the tooth, applied hot water with a syringe at the base of the tooth.
That was yesterday, C14 now has a temporary filling and if the pain does not come back i get to keep the nerve. There was a small cavity that he found, had no sedation done for the work, it hurt a bit but was manageable.
More info:
I have some discomfort at the right hyloid greater horn and from what i see in xray it went down a bit, no idea why.
Thank you for reading/replying!

 

[MattKW]

I don't understand the tooth numbering system you're using. Can you identify in another way? FDI or UNS?

 

[thomr]

https://i.pinimg.com/736x/76/3d/4c/763d4c093ecf82e8f3968b45b3e5df6f.jpg
c16 would be Right 16
c14 would be Right 14

 

[MattKW]

I think you mean FDI; here's your 2018 OPG renumbered. If I interpret your question correctly, the 16 has a temp filling; the 15 is root-filled (poorly); the 46 is very poorly root-filled. Hot/cold pain is likely coming from 16 as the cavity appears close to pulpal horn. If it settles, have it filled and all will go well. The hyloid horn (I think you mean hyoid) is insignificant - just caused by different positioning when the OPG was taken. Does this help you?

 

[thomr]

Almost, 16 has its root removed two months ago and filled, so after the large xray was done, 15 was done in 2013 or before and the temporary is 14 because using hot water it reacted (16 did not) and it did had a small cavity mark, and when he drilled it went down a bit. I still have some pain now, not that sharp pain from hot but a pain that comes and goes, more of a nag than that 10/10, but seems to come from under 16, if i bump the teeth i feel a shock, he tested it however with some cold spray and said it was non vital, meaning the root was gone all the way.
Now i'm afraid to fully test to hot, because last time(wednesday) it went very bad, could not stabilize and it lasted for 20 hours, meaning i had to hold cold water in my mouth (5deg from fridge) and had to exchange it every 3 to 4 minutes because when it got warmer(body temp) the pain came back. Thursday i had it checked and the temporary 14 was done but as i said there is still some pain around.
I could ask the dentist for that xray for 16, i had i done this tuesday and the filling(root removed) is visible

 

[MattKW]

Almost, 16 has its root removed two months ago and filled, so after the large xray was done, 15 was done in 2013 or before and the temporary is 14 because using hot water it reacted (16 did not) and it did had a small cavity mark, and when he drilled it went down a bit. I still have some pain now, not that sharp pain from hot but a pain that comes and goes, more of a nag than that 10/10, but seems to come from under 16, if i bump the teeth i feel a shock, he tested it however with some cold spray and said it was non vital, meaning the root was gone all the way.
Now i'm afraid to fully test to hot, because last time(wednesday) it went very bad, could not stabilize and it lasted for 20 hours, meaning i had to hold cold water in my mouth (5deg from fridge) and had to exchange it every 3 to 4 minutes because when it got warmer(body temp) the pain came back. Thursday i had it checked and the temporary 14 was done but as i said there is still some pain around.
I could ask the dentist for that xray for 16, i had i done this tuesday and the filling(root removed) is visible

Very confusing. Get me up-to-date OPG or at least a bitewing pls.

 

[thomr]

Will try to get the latest bitewing from 16 but it would be just two months over the 2018 OPG. I have an appointment tomorrow.
A question would be, based on those two OPG's do you think that there might be something wrong there? That whole 16 area towards 15

 

[thomr]

Hey Matt! This is 16 bitewing. https://imgur.com/a/vESNpBZ
How does it look?
Thanks!

 

[thomr]

@MattKW

 

[MattKW]

Hey Matt! This is 16 bitewing. https://imgur.com/a/vESNpBZ
How does it look?
Thanks!

OK, so 16 has had an RCT, and shouldn't be a source of hot pain, although there is a possibility of a missed 4th root (mesiobuccal-2) that might still trigger pain. 17 looks OK, 15 OK (very rarely 2 canals). If there's a nagging discomfort when tapping 16, then it may be that the RCT has not been successful.

 

[thomr]

He found a cavity in 14 that he filled with temporary stuff. Since then, about 2 weeks ago, i still have that temporary, said he put some zinc calcium something there and it helps heal and leave it temporary until pain is gone and then fill. Every monday i went for a check.
That hot reaction went away with 14 being fixed, now just some small discomfort sometimes with even room temp or cold, hot reaction seems to have gone away.

What long term issues can i have with 16 if it has a missed root? Knocking does not provoke pain just normal sensation but now if i try chewing something hard, 5 minutes later knocking feels a bit off.

 

[MattKW]

If no pain, and you can eat with it, then it's going OK. but be aware that the RCT in 16 (and 15) are not good; the canals are underpacked and short of the apices. You may develop pain here in the long term. See how it goes.

 

[thomr]

A quick update, the pain eventually stopped, so now i have no reaction to both hot or cold food, everything is normal. The temporary filling in 14 stayed there for almost a month and was filled.
Thanks!

 

[honestdoc]

I'm sorry, I'm not familiar with your numbering system. Here in the US, it is tooth #3 molar, #4 premolar (bicuspid). It is difficult to judge the poor fill quality of the root canal treatments from the x-rays alone due to its 2D nature. Filling the root canal short does not necessarily mean it will become a problem. Almost all canals terminate short of the apex on one of 4 sides. I will upload that article from my home computer.

The best thing to have happen is there is no pain and no swelling. I see potential food trap and open proximal contact between #3 & 4 which can cause some low grade chewing pain. Hopefully, the teeth will settle asymptomatic and have crowns placed on them.

The latest studies and information for upper first molar root canals have many potential pitfalls. Obviously the MB2 canals is a pain to locate and instrument. It can also bifurcate and have lateral canals. The bacterial species Enterococcus Faecalis is resisting 50% bleach irrigation. Unfortunately those molars tend to have high failure rates.

 

[honestdoc]

Here is the attached article that illustrates length of root canals compared to x-rays.

 

[thomr]

Hello, i am "back". I believe i am getting an abscess on that 16 that i did here last year. https://imgur.com/a/vESNpBZ
I will go to the dentist this week but i'm pretty sure it's an abscess, periapical. My question is, given that i had issues with this tooth, had work on it done, and it's still an issue, should i just remove it to be safe? I'm not sure about removing it given how that maxillary sinus might evolve without it and the fact that it's not in the back aka a wisdom tooth. Can it be saved? What should i do? Change dentist maybe?

On that abscess, there's not much pain, just a small bump on the outside where the top part of the root should be, if i touch it it feels funny.

adding the 2018 OPG from above for reference https://www.dentistry-forums.com/attachments/capture-jpg.1561/

 

[MattKW]

If you want to save it, then go to a specialist endodontist. Otherwise extract it. No effect on maxillary sinus; the usual risk of perforation is there, but rarely occurs..

 

[thomr]

I went to the dentist after i posted here, he said it's nothing and that was it. If i touch that area with my finger and press i get a sensation as if i'm pressing on an open nerve, not a very sharp stab but that's how i would describe it as it goes away after removing pressure. A month has passed and the same sensitivity to pressure is present. Here's how it looks. https://imgur.com/a/KAZTr37

 

[thomr]

I can feel something there sometimes even when i smile. @honestdoc @MattKW any input? Thanks!

 

[thomr]

This was done this week https://postimg.cc/Yh6ysyh0