Loose Crown, Cracked Crown, or Failed Root Canal

[arod1hater]

I had a root canal and crown on #20 in October 2008 without incident. X-Ray showed (prior to) large dark area just under the large filling. Dentist felt the old filling had a hairline fracture, which allowed bacteria to get into the tooth, causing decay.

I had no symptoms whatsoever, no sensitivity to heat or cold, nothing But It was obvious from the X-Ray, to me there was a problem with #20 and something had to be done in October 2008.

The root canal and crown procedures went fine with no complications afterwards

That was until Sept 29th, 2009, when I noticed the check side of the tooth hurt like bloody hell with just the slightest bit of pressure applied. And I do stress SLIGHT. No such discomfort with pressure applied to the top of the tooth or to the tongue side of the tooth. I have for the most part been able to eat and drink normally. Although I haven’t chewed on that side of my mouth from that point on. And honestly haven’t done so since Sept 2008.

I did floss on Sept 28th and am curious if that loosen the crown. I could not floss once I notice the pain. I’m not a regular flosser… never have been.

It’s like I felt the crown had all of a sudden loosened up on Sept 29th. Perhaps the crown wasn’t sealed properly which has allowed foreign substances to get underneath the crown causing decay to the remaining tooth on that side.

I’ve been taking Clindamycin since Sept 29th as I had a supply of it on hand, and in case of infection, as I could not get into the dentist right away, I felt it was the most responsible thing I could do. I am experienced enough with meds to know it couldn’t hurt.

I saw my regular dentist (only seen him ONCE however as I recently changed due to a move) two days ago. He took two X-Rays. I noticed on one that the post did not extend to the bottom of the root anymore. My first thought was that my Crown may have "popped up" a bit becoming slightly loose allowing the post to move upward off the bottom of the root canal or that the post itself was TOO SHORT to begin with.

There was no sign of tenderness or redness on Sept 29th on the gums, either around or near the tooth or near the bottom of my mouth. It was only the excruciating pain I felt when I barely touched #20 on the cheek side… which i think is very odd.

MY QUESTIONS ARE:

1) Is it more likely that the Crown wasn’t full sealed and seated in the first place unseated which has allowed decay causing the strangely located pain?

2) Is it possible the tooth is cracked?

3) Is it more likely the root canal was not successful?

The Endodontic stated today he had no way of knowing if the tooth was cracked, if the root canal was the cause, if the shortened post was the cause (which his one X-ray didn't reveal)... etc. The way he examined the tooth was by first numbing the entire area up as I could not be examined otherwise, then pushing down on the tooth with his finger, then using a pick to press into the gum around the tooth and calling out the numbers… 2-2-2, 2-3-2. That was it.

His recommendation was to retreat the root canal or get the tooth pulled and get an implant.

I would like a professional speculation type opinion from you (best guess)...

Any advice you could give me would be greatly appreciated, as I do not trust my new Dentist and his "recommended Endodontist" I had the pleasure of seeing today.

ALSO Should I continue on the Clindamycin for the full 10 days?

Sincerely,
Kelly

[arod1hater]

The Endo gave me two options. Either to retreat the root canal and hope the crown doesn't break in the process OR get the tooth pulled and get an implant.

He never mentioned the possibility of the crown being loose until I mentioned that as a possibility. He stated he couldn't determine if decay was present under the crown without venturing in, possibly damaging the crown.

He then went back into his speel about retreating the root canal as a possibility and asked if I wanted him to perform the retreatment there and now. I decided to wait. I believe another opinion would do me more good than an unnecessary root canal retreatment.

Do you think an implant would be the best option given the strong possibility I have a loose crown with probable tooth decay?

[scottma]

Horizontal fracture of root is generally revealed by x-ray. Vertical fracure in the early stage can not be detected by x-ray. However, cilinical symptoms such as abscess or gum swelling may occur. In addition, a surgical exploration can reveal a crack line.Short post is probably not the cause of clinical symptoms. If there is no radiographic pathology identified on x-ray, redo root canal is probably not helpful.The number reading is the depth of periodontal probing,if these numbers are correct, you have healthy periodontium, which is not consistent with root fracture.You ned to differentiate whether the crown is loose or the tooth is mobile.Sometimes it's difficult to differentiate between the two.If the crown is loose, bacteria tends to enter inside of ctown and results in decay. In thies condition, meticulous probing generally can detect decay around the margin of crown. If the tooth is mobile, it probably results from occlusal trauma, x-ray exam may reveal widening of periodontal ligament. Seeing a competent and experienced dentist is advised.