Severe pain after root canal (going 3 months in now)

[Twister]

This is my going to be my 3rd month since I did a root canal treatment in which I believe is 1-1 or 2-1 (front)

I have experienced severe pain in my tooth since right after root canal treatment, and been to several dentists who have said there is nothing wrong and all looks ok.

Can any dentist here check my x-ray and give their opinion or see if they find anything wrong?

Pain is constant, but is knife sharp pain shooting up every time I try to bite, or apply any pressure.

Also trouble to sleep at nights, only get in about 3-4 hours per sleep at night and wake due to pain. (lasting for weeks)

On the verge to pull out the tooth myself If can't get resolved.

(Before root canal treatment, I had no pain in the tooth or infection, so I don't even know why the dentist performed a root canal on it in the first place, maybe also somebody else can tell me based on the x-ray)

 

[Dr M]

GP is the filling material that is used to fill the canal. It looks like there is some extruding through the apex, and this could cause an irritation to the surrounding tissues. Luckily a central incisor is usually easy to re-do. I would start by maybe opening the tooth up again and try and do a re-do of the root canal. You can do this at another dentist, but then you might have to pay again.

 

[Twister]

GP is the filling material that is used to fill the canal. It looks like there is some extruding through the apex, and this could cause an irritation to the surrounding tissues. Luckily a central incisor is usually easy to re-do. I would start by maybe opening the tooth up again and try and do a re-do of the root canal. You can do this at another dentist, but then you might have to pay again.

This is what I did, i went to another dentist and explained the problem.
But cut short, she removed the old filling, all pain subsided and were gone after (when old filling was removed)
Been 1½ weeks now, with no pain in the tooth anymore.

Today I got the new filling in the tooth, will send new x-ray and i hope no pain again , was god blessing to be without pain for 1½ weeks.

Let me know if this filling is better, or if there is any difference.

She also asked me if I got punched in the face on my front tooth, because of the black circle on x-ray, i said no, and that the tooth will eventually be needed to be pulled out in the future if get worse, i had no idea about this and suspect the previous dentist caused this trauma???

 

[Dr M]

The root canal does look better. I suspect a re-treatment was all that was needed in this case. Hopefully you won't have any further issues.

 

[Twister]

Yes I hope so.

I still have a lot pain now compared to before (when tooth had no filling in root canal) but I am hope that is normal you feel pain again for 3 days after doing a root canal even if it's a re-treatment.

I also feel pain in the gum, I think because the claff they put around the tooth when root canal fill was put on incorrectly, or too tight and also crushed my gum so have painful in that area too.

 

[Twister]

Please could someone answer if it's normal to feel pain in the tooth after a re-treatment root canal.

 

[Dr M]

It is normal to feel some pain for a while after a tooth was root canal treated. It takes a while to settle. Sometimes even up until 3 months. The pain should gradually decrease. If not, then alternatives need to be considered.

 

[Twister]

My pain have gradually increase again , for each day more and more , to the point again half my face is numb , my nose is numb , I can barely have my eye open. Painkillers doesn't work or help.

I think there is something serious wrong, considering that it was night and day difference when no filling was inside the tooth.

There must be something missing on the x-rays, now i just wanna pull the tooth out.

All paracetamol helped with was the fever, not the pain, and yes ive developed a fever again since i had a new root canal.

Please see attached xrays, and say if it can be/mean anything. (in the yellow circle)

 

[Dr M]

The root canal does not look bad at all. I think there is a chance that the tooth has a fracture which you cannot see on this 2D image. If the root canal was re-done, but the pain is increasing, with some sensory fallout, I would recommend considering an extraction. Perhaps do a temporary 1 tooth partial denture, until healing stabilized and then replace with a bridge or dental implant.
I honestly think it has reached that point.

 

[Twister]

Ok thank you for your input. I also think my last root canal was done in excellent condition, so I also think it is a fracture at this point. My dentist who performed the root canal also said there is nothing wrong with it and also think it could be a fracture.

Still symptoms are sensitive and severe pain to tooth when applying bite pressure/force, or if touching the tooth with fingers, or if I try to blow out air/spit it hurts the tooth, and the pain feeling is like I had fell and hit the tooth on the edge of a table.

I got re-scheduled to a endodontist, maybe he will or can find a fracture on the tooth.

What just is weird to me is, how the pain got reduced when I had no filling in the root canal, could the filling cause pressure or pain against the fracture?

and.. this is all started after my first dentist did RCT on the tooth (in a very careless manner I must say), could this have caused a fracture in the tooth?

and.. lastly, I don't know about your country, but if this incident happened there, that a dentist caused a fracture in a front tooth after RCT, could the patient get any compensation for the damage if its leads to extraction of the tooth?

 

[Dr M]

It is most likely that pressure from the filling material, on the fracture line, could cause pain. It just depends on where the fracture is and how severe it is.
A root canal that was not performed according to standard procedure could lead to various complications, including fractures or perforations.
In my country, the dentist can be held accountable yes, but it must first be reported to the regulatory body that governs dentistry in your country, and then there must be sufficient evidence that the dentist was negligent in a specific way after an investigation was performed. This takes a while

 

[Twister]

I am going to ask perhaps a very odd question you most probably don't hear every day, but how far/deep can the fracture have to be, to "save" the tooth? I attached 3 samples of range, and if the fracture is is outside the orange area (and ends before enter orange area) how deep can it go, for the tooth to be saved, and is it possible to "drill" away the fracture/part of root and put filling in afterwards and build a crown?

So if the fracture is outside the orange area, to remove all that is fractured and parts of root , and put in artificial cement or filling, and then crown the tooth. (if the fracture isn't in the orange field)

Would such a thing be possible, or would it make the tooth too weak to support it in the bone?

 

[Twister]

You could reply by something like yes if the fracture is deeper down then this red line, then it wouldn't be possible to save it, or if not be possible at all, anywhere where the fracture is. I am just curious.

 

[Dr M]

If a fracture extends into the root or is below the bone level, then it cannot be saved. So on the last photo, if it extends below the bone, which is almost where the yellow starts, it cannot be saved in my opinion

 

[Twister]

Okay thanks for your expertise in the case.

Maybe this is the wrong forum, and topic to ask, or if I should create a new thread, but if it comes to the case that a extraction is required, and if I am considering a implant in the future (I have read implants are better too then bridges, is it true?), is it best to do a direct implant (insert implant right after tooth extraction) or wait until the site have healed before install implant?

Also is zirconia implants recommended more or titanium implant?

 

[Dr M]

Zirconia and titanium implants are both bio-compatible, and I prefer either one. An implant is always better, especially when compared to a bridge where the adjacent teeth are virgin teeth. Drilling on virgin teeth, always have the risk of damaging the nerve. But in your case, the adjacent teeth are not virgin teeth and one of them already has a root canal. After a root canal, we usually recommend a crown to protect it, so since the adjacent tooth has a root canal, a bridge could be an option, since it will protect that tooth with a crown. After the extraction, you would need to wear a temporary bridge for a while, to allow the bone and tissue to heal first.
Keep in mind, that a bridge does not last as long as an implant. And root canals don't last forever as well. So if the adjacent tooth's root canal fails, you might end up losing 3 teeth or units.
If you do an implant, it is best to do the implant placement with the extraction, if there is no surrounding infection of the bone and if there is sufficient bone. It speeds up the process as well. If the extraction proves difficult, or if there is infection or insufficient bone, then you might need to place a bone graft and wait for it to heal, before placing the implant. This can sometimes take 6 months before the implant is placed.

 

[Twister]

Ok thank you.

If I choose an implant instead of a bridge, is it still possible to connect the two teeth (the one that is extracted with an implant, and the one next to it that already has a root canal) where the implant tooth crown is connected to the root canal next to it with a crown forming a 2-teeth bridge. (but both have stabilize points, 1 from implant and 1 from the root canal tooth) or is it prefered to keep them seperate? (not connected?)

Also, how many teeth can a implant generally carry? If it's front teeth we talking about, would a impant in the front tooth be able to carry two teeth if ever the root canal next to it fails in the future?

Also the 3rd teeth in the same right side has a root canal and should need a crown aswell, dont know if its visible on the x-ray, but could then a 3-way bridge be possible linked from 1 implant, and 2 root canaled teeth, or would it be better to have implant sepeate, and link together 2 and 3 in a bridge, or just keep each and every one seperated? (no bridge link)

 

[Dr M]

You cannot connect an implant tooth to a natural tooth at all.
An implant can usually carry 2 teeth maximum. This is called a 2-unit bridge as well, and can only be done in cases where the occlusal forces are not severe.
In your case, I would suggest keeping them seperate.