Is it necessary to extract my tooth and get an implant?

[larryy]

Good afternoon everyone,

About 10 years ago, I had a large cavity on my upper left 6th tooth. I got treatment on one of the roots and had a silver crown inserted. For the last few months, I've had a bit of pus discharge from the gum above the upper left 6th tooth. I went to the dentist recently and was prescribed antibiotics for the infection. I also had scans taken and the dentist advised me that the upper left 6th tooth and roots need to be completely extracted and that I need an implant. I have no pain in the tooth and I am scared of having this procedure done.

Could you please kindly have a look at the attached x-ray scans and provide your independent opinion on this matter.

Thank you very much.

 

[honestdoc]

UL 6th tooth (in the US, the tooth is labeled #14) does have extensive damage and missed 2 (Mesial buccal and MB2) canals. The tooth does need to be extracted because it is a source for infection and contamination.

The extraction process for this case is not bad. Since there is already an infection, the bone around is softer and less prohibitive to remove the tooth (the body wants to get rid of any infected material). The tooth will come out in pieces so don't let that scare you.

You may not need an implant. Implants are expensive and are just elective. I think leaving the space is realistic. Back teeth will shift (tip) forward and the opposing tooth will erupt up. However, judging from the upside down bitewing x-ray, your bottom opposing tooth will not hyper-erupt due to opposing the tooth in front and the upper back tooth should minimally tip. As long as you are functioning without difficulties, you may not need an implant.

If you desire an implant for certain, I recommend placing bone graft immediately after tooth extraction to strengthen and prepare for future implant. You may also need sinus lift surgery to accommodate an implant.

 

[MattKW]

Extract it because even though the RCT could be redone, it has a poor crown on it that would need replacement too. Have to disagree about leaving a gap. Tilted teeth create cleaning problems. If you want to leave the gap, then I would suggest extracting the wisdom tooth to minimise risk of 2nd molar tilting over. Aim for implant in long term, but don't let whoever did the RCT or crown anywhere near this.

 

[honestdoc]

Leaving a gap is what most of my patients could only afford. I live in an expensive state and most of my patients are poor and put almost all of their money into housing/rent much less into dental prosthetics like implants. I have no opinion with removing the wisdom tooth to minimize #15 tipping. However I always prefer the least traumatic plan. I do agree that tipped molars create undercuts for food trap but I observe many patients adapt...they don't have much choice.

 

[MattKW]

True enough, we don't all have choices we'd like.

 

[Oceansightdental]

That tooth is very infected and needs to be removed ASAP. Additionally, the tooth is right on the sinus so most likely it is draining into your sinus cavity and causing a widespread infection. Start off by taking a few days of antibiotics, Augmentin or at least Amoxicillin, and remove the tooth and place bone graft to close the space. If you can afford an implant great, but at a minimum you should remove the infected tooth to prevent infection from spreading to the rest of your body.