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What Does This X-ray Report Indicate?

Posted on Tue, 27 Dec 2016

Question: I am looking for XXXXXXX most dentist opinion as per the X-rays attached, therefore kindly forward this to XXXXXXX most dentist. Overview of my problem as given below:
I am having tilted wisdom tooth and on the front tooth of the tilted wisdom tooth the root canal treatment was done around 5yr back along with filling on the RCT tooth which is the front tooth of the tilted wisdom tooth there was no capping suggested by that time and since then there is no pain till now but recently some part of that filling is broken from the sides and some how there is gap there which is causing the worry about the correct line of treatment. I have attached the images of OMG as well as both tooth x-ray to analyze and get the details with correct line of treatment step by step, kindly provide the details with steps and alternative options also.

Answered by Dr. Honey Arora (38 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
Welcome to HEALTHCARE MAGIC..

As per your complain and the image attached first of all I would like to know if is there any pain or sensitivity associated with Root Canal treated tooth or is it completely painless even on biting also..

Although the tooth is appearing alright; but would like to know from you so that I can guide you appropriately..

If the tooth is painless as per your description then it will be better to first get the wisdom tooth removed followed by capping of the Root Canal treated tooth..

Please revert back with answers..

Regards..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (11 hours later)

There is no pain as such, please provide the correct line of treatment step by step and more details around the x-rays sent, is the front tooth from the tilted wisdom tooth is getting damaged or not? Can filling be the option without extraction of wisdom tooth. Can capping of RCT tooth be without extraction as extraction is painful process which requires at least 7-10 days recover fully. What should the alternate along with the options with details and side effects.

Answered by Dr. Honey Arora (3 hours later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
Welcome back..

As per the IOPAR and Panoromic x ray attached I can very well see that your tooth has decayed also due to the wisdom tooth impinging and putting pressure of the wall of the molar tooth and also there is a small pocket formed that can be accumulating food debris leading to infection and decay..

The filling that is done after root canal treatment is also not appropriate which is because the wisdom tooth is impinging in the hole formed in the RCT tooth..

Removal of wisdom tooth is a must for proper filling or capping of your RCT tooth otherwise the filling will not stay in place as it will not be contoured properly due to interference by the wisdom tooth..
Also cap will not be made properly as the wisdom tooth is too much tilted in the place where the molar is..

Do not worry about pain during wisdom tooth extraction as you will be given local anaesthesia injection and the procedure will be painless..
But better to get it extracted by an Oral Surgeon..
Yes, recovery will take 8 to 10 days to recover but you can wait this long for a better treatment that will be long lasting and will increase life of your tooth..

So step by step treatment will be as follows:

1. First get the wisdom tooth removed and wait for atleast ten days for it to heal..
2. Once the healing occurs get the RCT tooth prepared for cap and get a cap placed..

This is the best option in your case and I would not suggest you to proceed for filling or capping without extraction of wisdom tooth..

Please let me know for further questions..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Honey Arora (26 minutes later)

I have heard there are complications as sometimes wisdom tooth might be broken as the nerves for it may be under the gums and its quite complex to remove it those complications comes when you start extraction. Please provide details.

Answered by Dr. Honey Arora (10 minutes later)

Brief Answer:
Not always necessary for complications to arise..

Detailed Answer:
Hi..
Welcome back..

As per your query, yes it is true that it is tricky to remove wisdom tooth but it will be always a complicated procedure and will cause problems is not at all necessary..

As your wisdom tooth is already impacted, it will be removed by surgical extraction only in which gum will be reflected and some portion of bone will be drilled and tooth can be removed in parts..
It will be followed by stitches that will be opened after 7 days..

It is a routine procedure and an Oral Surgeon can do it very efficiently so do not worry about it and proceed further..

Please write back for further questions..

Regards,

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Honey Arora (1 hour later)

Do you think at my age of 45yrs this wisdom tooth will still create friction to the front RCT tooth, i think its been idle since more than 5 years now without giving any issues either while eating or not any sensation as well.

I am thinking not to go via surgical route to create further issues, need you opinion with details but definitely want to cap the RCT tooth. Do you think it is going to be suggested route, may be there need to some drilling around it to make space for cap is that going to be easilier without going for extraction? Kindly provide details.

Also need thoughts and life on half metal half ceremic caps on RCT tooth.

Answered by Dr. Honey Arora (22 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
Welcome ba ck..

As per your queries, the RCT tooth will be trimmed and made smaller to let the cap fit over it but as you too can see the x ray and you will find that the wisdom tooth has its tip a bit inside the hole of the RCT tooth and if a crown ha to be made it has to cover the tooth completely, otherwise it can be a failure and there can be seepage of food in between the cap and tooth..

If the wisdom tooth is drilled to make space for the cap then the enamel will be lost while trimming the tooth and it can become sensitive to hot and cold and will again cause discomfort..
So this is not correct procedure even if you are advised this way by any dentist..

If you still wish you can get a properly contoured filling over the RCT tooth done and if it fractures still, then no other option then the way I suggested is right..

As far as half metal and half ceramic crown is concerned, the chances of chipping of the ceramic are higher but still works well..

I would however suggest you that you should go for complete metal or full metal ceramic crown...

Please write back for further queries..

Regards.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Honey Arora (5 hours later)

Can you please revisit the x-ray and see the possibility of filling the RCT tooth as and when the pain in wisdom tooth i am planning only to extract then. please guide with details along with the issues.

Answered by Dr. Honey Arora (2 hours later)

Brief Answer:
Yes..

Detailed Answer:
Hi..
Welcome back..

I have already told you in previous discussion that you can go for filling of the tooth and if done properly it can stay in place..

And in case if it continues to fracture then you can proceed for getting extraction of wisdom tooth done..

This I told you keeping in mind about your wish of not getting extraction done..

Hope this helps..

Regards..

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Honey Arora (19 hours later)

Thanks for reply, actually if you look at the x-ray there is black hole on the RCT tooth if filling can be done on that then you mean to say that fracture on the filling or fracture on the wisdom tooth. Also explain the complications after the filling with out extraction of tooth. What if filling is not done and leave the situation as it is.

Pl explain, need you opinion before going for either filling or extraction, the idea is about winters in which the pain will be more on stitching and extraction. Therefore please explain the treatment plan with the pros and cons in details.

Answered by Dr. Honey Arora (3 hours later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

Yes, the filling will be done to fill up the black hole but you can see in the x ray that the tip of the wisdom tooth is somewhat encroaching the hole..

I was talking about fracture of filling and not wisdom tooth..

The side effect of doing filling without extraction of wisdom tooth is improper contours of filling or some areas will remain under and filling will break under forces of chewing..

Even the spaces left unfilled can accumulate food debris and infection can recur..

Even if left as it is, there will be food accumulation and can infection..

Extraction will be done by numbing the area and post extraction also antibiotics and painkillers will be given so pain and infection will be controlled...

Please write back for further queries..

Regards .

Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee