This case highlights how simple dentistry done well can ease a patient’s dental pain, get rid of a source of long-term chronic infection and prolong the life of their existing restoration.
It also highlights what is good and bad about “screw posts” as seen in the before picture. Screw posts were often used as a quick fix when a proper post could and should have been used. It is easy to say what is bad about screw posts- they were a common source of root fracture, they were associated with higher rates of failure (usually through root fracture or decay), they did not retain the core restoration well (which is a really bad design flaw as retaining the core is the primary and actually the only point to a post) and they were prone to deboning. It is less easy to say what was good about them other than that they were relatively cheap (if you don’t count the cost of failure) and quick to place. From my point of view, however, the best thing about them is that they are easy to remove and so on this occasion I was able to remove the old post and root canal filling by working through the existing bridge rather than having to cut it off or risk fracturing the tooth by attempting to remove it whole. The only alternative treatment would have been to extract the tooth and so lose the bridge as well. With this approach, the bridge has a good future and the patient is out of pain and infection free.
When redoing a root canal filling (on this occasion because the patient had developed a painful acute abscess, from the chronic infection at the tip of the root) it is very important that we find the cause of the infection and treat it appropriately. On this occasion, the problem related to a root canal filling that did not seal the full extent of the root length and was not completed under ideal conditions the first time. Fortunately, for the retreatment, I was able to visualise the whole canal structure using my surgical microscope and could create ideal conditions by sealing around the tooth with a tight sheet known as rubber dam. The second radiograph was taken 3 years after retreatment and it shows that the dark shadow around the tip of the root (which denotes the area of infection) has gone, indicating that the infection has healed and the body has laid down new bone around the root tip.
If you are suffering from dental pain or are worried that you may have a problem with an existing dental restoration or root canal filling then please do not hesitate to contact the surgery on 01580 752202 and we will be happy to help. If you want to know more about dental pain- why we get it and how we fix it then please click on the link below.