2 periodontist 2 opinon

[s0022jh]

so I've seen two periodontist for opinion due to my 2nd molar on bottom left had root canal done years ago, potentially had fracture near root now, sometime its sored/hurt. also gum pocket about 7/8mm deep on that molar had some bone loss. both periodontist agree with this diagnosis.

But 1st one recommend me for a dental implant to save the trouble for future fix, the other one said my gum near molar is in good shape, and the tooth is not wiggling, recommend to open the gum, fix the fracture and any other issues(such as deep gum packet issue).

I don't know which one I should choose, I would like to keep my tooth, I brush twice daily, use floss + mouth wash every night, so my gum everything is good, except that molar issue. But I don't want fix it now only have to have it replaced with implant few years later.

Base on my symptom, any dentist on this forum has any opinion on this? How would you even fix fracture that's near root, and how to fix the deep gum packet issue, so no future bone loss occur?

 

[MattKW]

I don't believe you can fix a fracture using a periodontal approach, unless you're removing a root (hemisection).

 

[honestdoc]

I think the tooth in question needs extraction. I agree with Dr. MattKW that you cannot repair root fracture. Usually the 2nd molar roots are more fused together than first molar making hemisection less predictable.

What are the treatment options for the missing tooth? My opinion is either leaving it alone (less traumatic, less costly) or placing implant. A lot of my patients cannot afford implants so they usually leave the space. The consequence is if you have an opposing molar, it may hyper-erupt down.

 

[s0022jh]

well its either dental implant(from 1st doc) or fix the fracture and bone loss(from 2nd doc), I prefer latter but don't want complication in few year, and then have to do the dental implant anyway. the tooth is not wiggle at all, gum is good, just some bone loss, deep gum packet and potential crack near root. I guess for most crack root means take out the tooth? not fixing it?

so its better to do implant vs hemisection(or whatever surgery needed to fix the tooth)? not worry about the cost, but like to have done it once surgery and forget it about it.

 

[s0022jh]

i attached my xray, couldn't really tell if there is a crack root. hopefully someone know how to read it could tell me more about it. i had a crown and root canal done years back, the soreness only happen in recent year.

 

[honestdoc]

I cannot diagnose root fracture from the image. One way to diagnose is to perio probe for attachment loss. If probe readings are Withing Normal Limits, it may not be a root fracture. What kind of pain are you experiencing? Maybe you maybe grinding/clenching? The tooth in question is the first molar not 2nd.

 

[MattKW]

That is not a deep enough X-ray for me to comment. I need one that shows the full length of the roots so I can look at the quality of the RCT and if there is any pathology at the tips of the roots. From that bitewing Xray you appear to have good bone levels at all other teeth, so I have to wonder why just this one tooth is troublesome.
It could be from the RCT that is mimicking a perio problem (an "endo-perio" lesion). The RCT looks as though it has been done by a general dentist. More X-rays at greater depth please.

 

[s0022jh]

ok thanks from xray do you guys seem any other issues? the soreness is occasionally not all the time, but when I bite down hard stuff, my 1st molar become sensitive.

here is another xray. I notice a vertical dark area near the right side of tooth? could this be the deep gum packet issue or something else

 

[s0022jh]

I cannot diagnose root fracture from the image. One way to diagnose is to perio probe for attachment loss. If probe readings are Withing Normal Limits, it may not be a root fracture. What kind of pain are you experiencing? Maybe you maybe grinding/clenching? The tooth in question is the first molar not 2nd.

does grinding/clenching cause soreness/tenderness issue? if so why only that tooth.

 

[MattKW]

ok thanks from xray do you guys seem any other issues? the soreness is occasionally not all the time, but when I bite down hard stuff, my 1st molar become sensitive.

here is another xray. I notice a vertical dark area near the right side of tooth? could this be the deep gum packet issue or something else

That's just another Xray taken slightly more forward, not deeper. The root fillings look suspicious even at this shallow depth.

 

[s0022jh]

I'm curious from xray of that 1st molar, can you tell if there are bone loss? it seem its same as my other tooth?