Implant Or A Root Canal

Tooth #9 and 10

No periapical pathosis over tooth #10

Failing implant #9


4 Responses to “Implant Or A Root Canal”

  1. Dr. Pancake says:

    I believe this is actually an artifact of CBCT imaging that often happens with implants. I do not believe that implant is failing from the radiographs you have shown. I hope you didn’t tell the patient to remove the implant based on that sagittal CBCT Slice

  2. I appreciate the comment. It is possible that the cone beam does show scattering artifact. This case is rather interesting from the standpoint of patients pain and at the same time, the absence of definitive signs of problems on imaging. She was seeing a periodontist and a prosthodontist for further consultations. I will update this post as soon as I see this woman for a follow up.

  3. Fred Barnett says:

    Hi Vlad,
    I would consider the dark areas to be “beam hardening artifact”.

    If the implant site had signs of mucositis or perimplantitis, then that changes the situation, but you did not find any disease associated with the implant site. Is tooth #10 taking more of the occlusal load than the other teeth?
    Interesting case–keep us informed on how it progresses.


  4. Thank you for your comment Fred. Yes the beam hardening effect has been considered. Her periodontist next door, took the implant out and we had a discussion about it. The implant came out super easy and wasn’t really integrated. However, her discomfort is not resolved completely. Her prosthodontist made a temporary Maryland bridge and since then, I opened tooth #10 and placed calcium hydroxide since I did not find anything wrong with the root canal or any fractures. She is in a holding pattern at this time. This is proving to be an interesting case where we really don’t know what is causing her pain, yet she points to the same area of 9-10. I will keep track of this so I can share what happens.

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