Root canal treatment after bridge

[CarrieAnn]

I had my original 5 tooth bridge nearly 20 years ago and recently decided to have it replaced as I wanted a better fit and a more natural appearance, even though it was not causing me problems. After the new bridge was in place I began experiencing pain in one of the supporting teeth and have now had root canal treatment as the tooth was infected. I am now experiencing the same pain in another one of the supporting teeth (3 teeth hold the bridge) and I have been perscribed antibiotics and my dentist has asked me to wait and see if this second tooth settles. If it dosen't more root canal treatment is on the cards.

My dentist said he was not surprised that the first affected tooth needed root canal work as he could clearly see the root through the filed tooth when he remove the old bridge. Is it unusual for root canal problems to occur after having bridge work? Could my dentist be at fault in anyway and caused this to happen given that my old bridge was not causing any problems. Will my bridge be compromised due to this root canal work?

[Zzzdentist]

Hi CarrieAnn, how's Dancing with the Stars going?

It's most likely not your dentist being at fault for the nerves abscessing. I don't know any dentist who would want that to happen accidentally or intentionally when replacing a bridge of that size. Sometimes these things happen, and often they occur unpredictably.

The work involved in removing the old bridge, cleaning up the supporting teeth (and rebuilding them if needed), plus the new cement/resin bonding to put on the new bridge can irritate the nerve enough to make it die if it wasn't in the best shape to begin with. Did your dentist do some tests to determine if the teeth were abscessing? Sometimes if the bite has changed, is too high, or interfering when you slide side to side, that could also cause some teeth to be achey. Often a bite adjustment can settle those problems down if that's the case.

The bridge might be perfectly fine even though root canal access openings have to be made through it. It just depends on whether there is porcelain or metal that they are going through. There's less chance of a problem if the access is made through metal. With porcelain there can always be a concern about porcelain fracture. Sometimes it's not an issue, but it can certainly be a concern. Your dentist would be able to tell you better about the risk of a problem.

You could also post your question up at Dental Fear Central and Mark Bornfeld's site here to get some other dentists' opinions as well.

[CarrieAnn]

Thank you so much for your reply. After spending £3,300 to replace my bridge and then discover I need to have root canal treatment (possibily for 2 teeth) on top, I am feeling really down.

The dentist took xrays before work began and found no problems. After removing the old bridge and replacing it with the temporary bridge my dentist gave me Corsodyl Gel and said it would settle the gums. Nearly a month later the new zirconia bridge was ready. On returning to have it fitted I mentioned to the dentist that during the month wait I had experienced pain when having hot drinks and had resorted to a straw. He did not think this was unusual and said it could settle and then mentioned that root canal treatment could be an option if it proved necessary. He fitted the new bridge. A week later I had one tooth drilled and cleaned out. 5 days after that, when my dentist was on holiday, I had to go back to his colleague who did a more thorough job of cleaning it out after it had flared up again. This 2nd dentist then perscribed antibiotics, do you think the 1st dentist was negligent in any way?

My new bridge is made of zirconia, is this stronger than other bridges? My previous bridge was metal, should I have gone for the same? Gosh I wish I had asked these questions before I proceeded with this treatment.

[Zzzdentist]

Sometimes even though a tooth is cleaned out to start the root canal, pain can still persist so further cleaning is necessary. Not all first time open and drains and pulpectomies are successful at taking care of the problem on the first try. Often the bacteria are in the bone so even cleaning out the tooth part doesn't necessarily mean everything gets better right away.

Asking a dentist whether they think another dentist did anything negligent is like opening a can of radioactive flesh eating space worms. For what it's worth, nothing that you have mentioned so far has set off any reg flags for this dentist. Nerves can be funny things. They may be fine for years and years, but the instant you do something new around them, they can suddenly abscess and die in protest.

I have found some resin cements more irritating to nerves than others. In particular, I remember having consistent sensitivity problems after using 3M Rely X ARC cement. After I switched to 3M Rely X Unicem, the problem disappeared. Usually a nerve is capable of surviving some irritants including new preparations and irritating resin bonding agents. Other times the tissue dies and root canals are needed unfortunately.

I haven't done any zirconia bridges, but the milled zirconia crowns I have done are very, very strong. In fact, they are incredibly difficult to create root canal access openings through. From that fact, I think they should be able to handle having root canals done through them. Your dentist probably would be able to tell you better since there are also different brands of zirconia crowns as well. The ones I've done are Procera and Cercon single unit crowns.

I don't think they are quite as strong as conventional porcelain fused to metal bridges, but the material is quite good.