What Do These Following X-ray Findings Indicate?

Posted on Tue, 27 Dec 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 27 Dec 2016 Answered on

Wed, 18 Jan 2017 Last reviewed on

Question : Please review the attachment for the recent RCT done and advice the findings and further correct line of treatment if required any with details. Crown is not done yet.

Please forward this request to the GUM specialist/Senior RCT specialist for review.

Answered by Dr. Honey Arora (29 minutes later)

Brief Answer:
Detailed below..

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

I have reviewed your x rays and the Root Canal Treatment is appearing to be appropriately done with proper filling of the canals..
The area under the root tips is also appearing healthy and infection free..
So in short, the Root Canal Treatment is looking good..

The next step in this treatment line is to get the tooth capped but should be done atleast after 20 days of the permanent filling..

I would also like to know that how is the tooth right now..
Is there any pressure or pain still present or the tooth is painless..
Is she biting from the treated side and is she able to chew without any discomfort?

Please revert back with answers..

Hope this information helps..

Thanks and regards.
Dr.Honey Nandwani Arora.

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

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

Can you please review the pictures again as there is some gum treatment advised after which the crown can be fixed, can you provide your details on the same as there might be food particles after the crown and gum which is required to be removed for that, provide your analysis with details after careful investigation.

Answered by Dr. Honey Arora (13 minutes later)

Brief Answer:
Please provide some details..

Detailed Answer:
Hi..
Welcome back..

As per your query I can appreciate some bone loss and nothing other specific radiographic findings..

Please explain in detail what gum treatment is advised to you before crown placement?

Also I would like to know is the tooth loose or the gum is swollen or painful?

I will try to relate clinical findings with radiographic findings so that I can guide you accordingly..
But first of all let me know what exact treatment for the gums is advised?

Please revert back..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (52 minutes later)

I have been advised Gingivitis to remove the affected gum which will create space between the crown and adjacent tooth, therefore could you please relate the findings and look at the uploaded images so that correct line of treatment can be started, also let me know the implications of fixing the crown on the RCT tooth without the Gingivitis treatment which will be given using laser, is it really needed or not so that to go ahead with crown post RCT. Please provide the approaches with details of pros ans cons.

Answered by Dr. Honey Arora (1 hour later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
Welcome back..

As far as the x rays are concerned, I can see some bone loss that is indicative of gum disease or gum infection, but does not seems so aggressive enough..

So if I can tell you as per the x ray you can go for deep scaling or cleaning of teeth followed by placement of the crown and hopefully it will respond well..

I also want you to answer my questions so that I can have a better view of the problem..
I am repeating the questions:

I would like to know is the tooth loose or the gum is swollen or painful?
Do you have any problem like bleeding from the gum or pain in gums?
Is the tooth/teeth appearing loose?

Please revert back with answers..

Regards.

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

Follow up: Dr. Honey Arora (39 minutes later)

I would like to know is the tooth loose or the gum is swollen or painful?
No
Do you have any problem like bleeding from the gum or pain in gums?
NO
Is the tooth/teeth appearing loose?
No

The issue here is to place the crown with the gum reduction as the crown will fit on the RCT affected area but there will be gap in the crown and gums.

Please let me know the correct line of treatment with the solution as to go with the crown or not and what will be consequences if crown not placed now.

Will there be any issues related to hard bites or cleanness of the RCT area.

Answered by Dr. Honey Arora (9 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi.
Welcome back..

As per your explanation it seems that you are advised crown augmentation procedure and in case if there will be gap between the crown and gums then it will be better to go for the gum reduction procedure that will also help in providing more XXXXXXX to the crown over the tooth also and it will help in better strength and longevity of the crown..

If you do not get the crown placed now then there are chances that on eating anything hard there can be fracture of tooth as after root canal treatment the tooth become brittle and can fracture under sudden blow..

Although if the permanent filling is done properly with proper contours then the cleanliness or biting can be easy without any problem..
Proper brushing of teeth, flossing and using antiseptic mouthwash gargles can help in maintaining proper cleanliness of the RCT tooth as well as entire mouth..

If possible please click a picture of the RCT tooth so that I can see its length and decide that do you need gum reduction or not..

Regards.

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

Follow up: Dr. Honey Arora (22 minutes later)

Is there any pressure or pain still present or the tooth is painless..
YES
Is she biting from the treated side and is she able to chew without any discomfort?
Not Started yet from treated side

I have already uploaded the pre-case and post case images earlier, requesting you to kindly deep dive into that and provide the solution. There are 3 images which i had uploaded while starting the ticket. Please elaborate some more with details after looking all 3 images posted earlier.

Pre-case image=R2
Post-case image=R5 & R6

After investigating the 3 images, kindly suggest whether the crown can be placed without gum reduction or not. If either of the case, what are the implications or issues. Whether metal+ceramic crown is suggested here then approx. what would be the charges.

Answered by Dr. Honey Arora (31 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
I am asking you to click a picture of the tooth directly from mouth and not about x rays as I have already evaluated the x ray every time I answered you..

As far as my judgement from the x ray is concerned, there is enough of tooth Structure present and if you ask my view after evaluating your x rays exclusively then I do not thing that crown augmentation is anyway needed..

But in post treatment x rays the tooth structure is not visible and only the roots are visible so just asked you for an image clicked directly from the mouth to look for tooth structure present..

A proper permanent filling followed by an appropriate tooth preparation and a metal- ceramic crown will efficiently do the job..

A metal-ceramic crown will cost around 2000-3500 rupees .

Please revert back for further queries..

Regards..

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

Follow up: Dr. Honey Arora (44 minutes later)

Pl review the image.

Answered by Dr. Honey Arora (1 hour later)

Brief Answer:
Needs gum reduction..

Detailed Answer:
Hi..
Welcome back..

As per the image attached, the tooth structure left is less in height and to get the proper fitting of the crown so that it does not get detached again and again, it will be better to get the crown augmentation procedure done so that there will be sufficient height of the tooth available and crown will bond strongly..

So it will be a better option to get the crown augmentation done..

Please write back for further queries..

Regards..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (10 hours later)

I had been told Rs5500/- for metal ceramic crown, are there any qualities as per earlier response metal-ceramic crown will cost around 2000-3500 rupees .

Answered by Dr. Honey Arora (3 hours later)

Brief Answer:
Yes, higher qualities available..

Detailed Answer:
Hi..
Welcome back..

Yes, higher qualities and procedures are available in ceramics like Zirconia, CAD-CAM,High strength ceramics and depending upon the quality the prices can go higher..

Which quality and procedures are you advised?

Regards..

Above answer was peer-reviewed by : Dr. Remy Koshy

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

Not sure about the quality as i have no idea therefore please provide details with charges. Also help as there is swelling on gum today yesterday it was not there. What can be the reason please refer the image sent last of whole mouth yesterday, shall i wait for the crown augmentation procedure as i am only using one side for chewing. What would be the consequences if placing crown directly with augmention is there any chance to avoid gum reduction. Kindly help.

Answered by Dr. Honey Arora (22 minutes later)

Brief Answer:
Gum swelling can be due to infection..

Detailed Answer:
Hi..

If there is swelling over the gum then it can be due to infection and you should consult your dentist and get evaluated..

As far as cost of the crown is concerned it can vary from city to city and even advanced techniques can even range upto 10,000-15,000 rupees..
What I gave you the approx, cost is of the regular metal ceramic crowns commonly used by Dentists..

So my suggestion is to consult your dentist and discuss about what kind of ceramic is being used and in case if he is using high strength ceramic then 5,500 rupees is appropriate cost..

As far as crown augmentation is needed, if you take my advise getting crown augmentation done that too with lasers is a blood less and a very easy and quick procedure and it will be better to get it done for longevity of your treatment..

Please revert back with further queries..

Regards..

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Honey Arora (6 minutes later)

What can i do with the swelling any home treatment can help along with some antibiotics, please suggest. Also as advised by you after 20 days of RCT only crown can be fixed to avoid issues. I am only using my one side for eating to avoid RCT tooth which is upper last. Please provide details with correct line of treatment.

Answered by Dr. Honey Arora (9 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..
Welcome back..

You need to take antibiotics and along with it do warm saline gargles..
Let the swelling subside..
If still the swelling does not subside or pain occurs then you need to get an x ray done..

Also once the infection completely subsides then only you should proceed for capping down..

20 days of time is given just to keep a review on how the tooth responds after RCT and if everything goes well then crown is placed on the tooth.

Please revert back with further queries.

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (9 minutes later)

Please let me know the antibiotics along with duration that can help to subside the gum swelling as its there post RCT 24-48 hours.

Answered by Dr. Honey Arora (0 minute later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

Amoxicillin 500 mg can be taken but as they are prescription drugs therefore you need to get it prescribed by your treating physician or dentist only..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (51 minutes later)

Is crown augmentation procedure or Crown lengthing procedure using laser is same or different.

Answered by Dr. Honey Arora (0 minute later)

Brief Answer:
Procedure is same..

Detailed Answer:
Hi..

The crown lengthening procedure using laser is same and the only difference is that when lasers are used the procedure become blood less and also healing is faster..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (23 minutes later)

Pl advice after looking at the images sent earlier the best line of treatment with steps again please.

Answered by Dr. Honey Arora (10 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

First of all take antibiotics for 5 days so that the swelling of the gum goes down..
Consult your dentist to check for any remaining infection..

If everything is fine then you can proceed for Crown lengthening procedure..

Wait for a period of 4-5 days to a week and in this period healing of the gum will take place..

Once the healing is complete then tooth preparation will be done for crown placement and then crown placement will be done in next 3 -4 days..

This will be the entire step by step process of your further treatment..

Please write back for more queries..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (22 minutes later)

What are the side effects of Crown lengthening procedure using laser as there might be chances of damage of adjacent tooth as well, please provide details.

Answered by Dr. Honey Arora (4 minutes later)

Brief Answer:
If done by expert, nominal chances of side effects..

Detailed Answer:
Hi..

Crown lengthening procedure does not generally cause and serious side effects, although some level of tooth sensitivity can occur as some portion of root is exposed, but it gets relieved in a week or so..

Secondly damage to the adjacent tooth is not commonly seen after crown lengthening procedure..

If done appropriately crown lengthening will not cause you any serious problems and will altogether help in improving the fit of the crown..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (18 minutes later)

As the RCT already done for the tooth as what some level of tooth sensitivity can occur as none portion of root is exposed, please explain in case of wrong understanding. Please review all the images again in case required.

Answered by Dr. Honey Arora (14 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

As your tooth is RCT treated, and as in RCT nerves are removed from the tooth to make it painless and remove infection, therefore the chances of sensitivity are almost negligible and the tooth will be painless after the procedure also..

So do not worry about..

Hope this helps..

Regards..

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (23 minutes later)

Thanks for the reply, can you please advice how much Crown lengthening for the gum is required vertically to have the crown fixed and avoid further issues, please analyze all the images before responding.How long the procedure take and what will be the duration.

Answered by Dr. Honey Arora (18 minutes later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

Yes, I have analyzed the images.
A crown lengthening of atleast 2-3 mm will be enough and it is a short duration procedure and will take about 15-20 minutes or maximum of half an hour for completion..

Hope this helps..

Regards..

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (7 minutes later)

Correct me pre-requisites that, swelling of gums/pus in gums should not be there but how do i know whether its there or not as i donot know the reason for swelling.

Answered by Dr. Honey Arora (2 minutes later)

Brief Answer:
It has to be checked clinically and x ray by dentist..

Detailed Answer:
Hi..

Swollen gums can be due to infection and if on pressing there is pus discharge then there can be pus formation..

In case if there is no pus discharge still there can be pus and it can be evaluated by taking an x ray and it will be done by your dentist..

At times taking antibiotics will resolve the infection and do not need any further extensive treatment to resolve infection..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Honey Arora (18 hours later)

Correct me if wrong understanding that after only gum swelling subsides then only crown lengthening procedure using laser should be started followed by crown measurement and fix. I am applying DOLOPAR DENTAL GEL on the affect area mean time.

Answered by Dr. Honey Arora (1 hour later)

Brief Answer:
Detailed below..

Detailed Answer:
Hi..

Yes, you are understanding correctly that after swelling subsides then only crown lengthening and measurement procedure should be carried out..

Let the infection and swelling subside first..

The Dolopar gel is analgesic gel and is used to relieve pain but will not resolve infection, so to reduce infection you need to take antibiotic too..

Hope this helps..

Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng