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Complications from Root Canal?

Some years ago I had a broken cusp on tooth #3. The tooth was asymptomatic before a crown prep was performed. The radiograph showed that the pulp chamber had not been penetrated and that the break was clean. The prognosis was very good. However, I saw a new dentist after the one I had worked for had passed away and it turned out that she was very heavy-handed; setting the burr to chatter on the tooth as she bore down. When the anesthetic wore off, that tooth was hotter than blazes and it kept me awake all night, also causing lingering discomfort for days. However, the crown was seated even though I detailed my discomfort because, by the time the crown came back from the lab, the tooth was calm. I ended up with a large palatal fistula and #3 required a root canal. The endodontist used copious amounts of bleach and injected some into the void caused by the abscess. Although the root canal was complete, I wonder if there was some tissue necrosis caused by bleach leakage that continued to erode bone away finally involving tooth #2 about a year later. I fear the cause might have been from the bleach spillage and the fact that there was quite a bit of cement overflow into the bone at the apex of the palatal root. The reason I am concerned that may have happened is because there was no crack, decay, or any indication that #2 should also become infected. My oral hygiene is excellent and I have no prior involvement elsewhere. Tooth #2 then had a root canal performed. Unfortunately, the infection did not clear up and #2 was identified as the source because of a J shaped lesion around the mesial root. #2 had to be extracted nearly 2 weeks ago. There was granulated tissue attached to the extracted root. I've had a bone graft in preparation for an implant. However, and here is the concern, I taste something foul on the distal of #3, and the granulomas have precipitated a question on my mind. I think that the bone loss on the mesial root of #2 was caused by undetected drainage and necrotic tissue still surrounding #3. I plan to discuss this with my oral surgeon, but meanwhile before I explain my theory; I want to know if I'm way out in left field, or could my suspicions be actually valid? There was a 3d image taken before the extraction and bone graft on #2 and there is something odd-looking where the cement overflow had been on tooth #3, although some of the radio-opaque areas has dissipated. I'm really worried and is why I took the time to carefully explain my situation.

Female | 55 years old
Complaint duration: 5 years from first problem
Medications: antibiotic courses
Conditions: none

3 Answers

Your case is quite complicated, with a series of events on two teeth over a course of several years. It is impossible for me to come in at this late hour and diagnose what may have happened. Based on the information you have provided, it sounds like the pulp in tooth #3 was necrotic, which necessitated the root canal. It is possible that when a small amount of sodium hypochlorite is extruded past the apex and into the surrounding bone, that there can be some temporary irritation and reversible damage to the periapical area. However, it is unlikely that this event would have any impact on tooth #2. Again, it is impossible determine without more information, but I suspect that tooth #2 had a vertical root fracture. If that is the case, I agree that tooth #2 needs to be extracted, bone graft, and dental implant. Good luck with the rest of your treatment plan.
Wow! Short answer is that if bleach had been injected into the abscess space, you would have had an immediate massive reaction. A J-shaped lesion usually indicates a root fracture. Given that you fractured a cusp on #3 previously, that is the probable cause for the problem in #2.
Hi,

The clinical scenario you depict sounds complex and it would be impossible for me to blindly render an educated opinion. My advice to you is to get a consultation from someone you trust. If there is one near by, try going to a dental school and get an opinion from a qualified faculty member.

Scott M. Dubowsky, DMD