RCT or extraction?

[Sweetpeas]

Hi guys. My dentist and oral surgeon gave me conflicting advice. I desperately need some help to make a decision.

My #30 was extracted years ago. #31 is tipping into the space. This year, I had repeat infection around #32 #31. There was abscess on the gum of #31. After 2 rounds of antibiotics. The pain and the abscess was gone.

My oral surgeon said #31 is non-vital. His treatment plan is: extract #32, RCT and crown #31 after a few months .

However, my dentist thinks #31 has a very poor prognosis due to the bone loss caused by the impact wisdom teeth and infection. He won’t bother RCT because it’s just waste of time and money. He suggested extraction of #31 and #32 immediately.

My biggest question is: What is the prognosis of #31 after RCT and crown? Is it likely to fail within 5 years?

Any advice is appreciated.

 

[honestdoc]

I wish I can see the entire tooth #31 as well as the root tip and bone on 30. How did the surgeon know 31 is non-vital? If 31 is vital, take out 32 first and see how the bone around 31 heals. Consider implant(s) if 31 bone heals poorly.

 

[Sweetpeas]

I wish I can see the entire tooth #31 as well as the root tip and bone on 30. How did the surgeon know 31 is non-vital? If 31 is vital, take out 32 first and see how the bone around 31 heals. Consider implant(s) if 31 bone heals poorly.

Thank you for your reply. Unfortunately, this X-ray is the only one I have. You can see the entire 31 if you click on the attachment. My #30 was extracted years ago and never got replaced.

I had repeated tooth ache and abscess on the gum of 31. Now the abscess is drained and the gum healed. There’s no pain. The surgeon said 31 is non-vital because there was no response from the cold test.

 

[honestdoc]

I see the whole tooth #31 now. It is a very tough call. I always favor the least traumatic which indicates saving #31. I get that the dentist thinks 31 has a poor prognosis. If 31 has any possibility of a fracture that may contribute to bone loss, then extraction is needed.

 

[Sweetpeas]

I see the whole tooth #31 now. It is a very tough call. I always favor the least traumatic which indicates saving #31. I get that the dentist thinks 31 has a poor prognosis. If 31 has any possibility of a fracture that may contribute to bone loss, then extraction is needed.

Thank you for your clarification. It’s very helpful.

 

[Sweetpeas]

I see the whole tooth #31 now. It is a very tough call. I always favor the least traumatic which indicates saving #31. I get that the dentist thinks 31 has a poor prognosis. If 31 has any possibility of a fracture that may contribute to bone loss, then extraction is needed.

Another question: Is RCT a must in order to save 31? Is that a possibility that 31 heals itself without RCT? Thanks！

 

[honestdoc]

If 31 does not respond to cold, its nerves had died (necrotic pulp). It is a source for infection. One option is to do a pulpectomy where the canals are cleaned and a paste called Calcium Hydroxide gets placed in to help heal the area and over time (about 2 months) if everything looks good (no pain, no swelling, good stable bone) to finish the RCT.