Bone loss from a root canal?

[tjarrr]

Hi, so I had a root canal done on a wisdom tooth a year ago and my understanding was that if you have a root canal, rather than a tooth extraction, you can avoid bone resorption. However, I had the root canal checked a week ago and while it still looks fine, my dentist seemed to be unsure about whether bone resorption was occurring around the tooth itself and the radiograph itself wasn't reassuring either. However, she told me the same thing -- that getting a root canal done does preserve the bone -- but her explanation was weird: according to her, it's because the pressure from the tooth above when you bite down provides constant stimulation to the bone. But how can this be, if the nerves of the tooth were removed by definition during the root canal and therefore there is no means of stimulation to the bone??? Basically I'm asking, am I going to have bone resorption? If so, in what areas? Alveolar bone, jawbone, or both?

Thank you!!!

[kavan]

Hi, so I had a root canal done on a wisdom tooth a year ago and my understanding was that if you have a root canal, rather than a tooth extraction, you can avoid bone resorption. However, I had the root canal checked a week ago and while it still looks fine, my dentist seemed to be unsure about whether bone resorption was occurring around the tooth itself and the radiograph itself wasn't reassuring either. However, she told me the same thing -- that getting a root canal done does preserve the bone -- but her explanation was weird: according to her, it's because the pressure from the tooth above when you bite down provides constant stimulation to the bone. But how can this be, if the nerves of the tooth were removed by definition during the root canal and therefore there is no means of stimulation to the bone??? Basically I'm asking, am I going to have bone resorption? If so, in what areas? Alveolar bone, jawbone, or both?

Thank you!!!

Pressure is still exerted on the bone whether or not the nerve is in the tooth. When you bite down on something, the force of that is transferred to the bone. Hence stimulation there.

[Meefly]

WHat about if you have an extraction followed by an implant? Does that help preserve the bone?

[LoveofScotch]

WHat about if you have an extraction followed by an implant? Does that help preserve the bone?

Yes.

[Lazlo]

Okay, I have an important question on this matter. VERY IMPORTANT.


If you have a tooth extracted and the space closed, does that mean you've lost JAWBONE? I.e. that the jaw itself has been resorbed where the space was closed or only the tooth is moved to cover that space?

I ask because it feels to me that I've lost both maxilla and mandible projection after extraction of four bicuspids and those spaces closed?

[LoveofScotch]

Okay, I have an important question on this matter. VERY IMPORTANT.


If you have a tooth extracted and the space closed, does that mean you've lost JAWBONE? I.e. that the jaw itself has been resorbed where the space was closed or only the tooth is moved to cover that space?

I ask because it feels to me that I've lost both maxilla and mandible projection after extraction of four bicuspids and those spaces closed?

Well, yes and no, but it’s not exactly the same. Or maybe a better way to put it…the adaptive response may be the same, but the potential repercussions are very different.

Bone is exceptionally hard to grow (so to speak), and arguably even far more difficult to maintain (requiring a very specific anabolic environment). When one no longer “needs” said bone the body will stop expending the enormous amount of energy that’s required to maintain something that’s no longer needed. And that isn’t bad per se.

In my humble opinion, the main potential problem with losing a single tooth would be the potential ramifications to the supporting structures of the adjacent teeth.

[tjarrr]

Pressure is still exerted on the bone whether or not the nerve is in the tooth. When you bite down on something, the force of that is transferred to the bone. Hence stimulation there.

But what about this: "Replacing teeth with full or partial dentures doesn’t solve the problem of bone loss as the dentures exert a very small amount of chewing pressure on the bone compared to natural teeth, as low as 10% or less." What is the difference then with the root canal-treated tooth, is it that the roots are still remaining?

[kavan]

But what about this: "Replacing teeth with full or partial dentures doesn’t solve the problem of bone loss as the dentures exert a very small amount of chewing pressure on the bone compared to natural teeth, as low as 10% or less." What is the difference then with the root canal-treated tooth, is it that the roots are still remaining?

Basically, yes. Chewing force is transferred directly to and through the root to the alveolar bone.

[kavan]

Okay, I have an important question on this matter. VERY IMPORTANT.


If you have a tooth extracted and the space closed, does that mean you've lost JAWBONE? I.e. that the jaw itself has been resorbed where the space was closed or only the tooth is moved to cover that space?

I ask because it feels to me that I've lost both maxilla and mandible projection after extraction of four bicuspids and those spaces closed?

Not sure how to 'answer' this one. If the tooth had to be extracted, say due to an infection or could not be 'saved', I don't think the space really closes. But the other teeth might change their orientations (move). In that case, bone loss to the aveolar process would visible in an X ray by a DIP right above the lost tooth (if from upper jaw) and right below it (if from lower jaw). Takes some time as it happens over the course of time and no I don't know the exact time.

If the 'tooth' was extracted for BRACES, (in which case it would be TEETH as 2, one on each side would be extracted) and this was done to COMPENSATE as to make the 'bite right', the OTHER teeth would be forced by the braces to CLOSE in on this space. Like the space is made to give the other teeth room to reorient to get the 'bite right'. In that case, you probably would not see the aveolar bone loss DIP you could see in an X ray if the tooth were extracted outside of the process of doing so to have braces. What you would see is a reorientation of facial bone structure. Worst case scenario is smushed in upper face and/or more retrusion to the jaw when the bite is 'made right' via ortho, eg skeletal class 2 types.

If extractions were done for braces to PREPARE for a maxfax surgery, bone loss would not tend to matter that much because it's done to make a GAIN towards advancement. Like you gain more than what is 'sacrificed' for the gain.

[tjarrr]

Wait I'm confused, do you have bone loss in just the alveolar bone or also your jaw bone??

[GJ]

Okay, I have an important question on this matter. VERY IMPORTANT.


If you have a tooth extracted and the space closed, does that mean you've lost JAWBONE? I.e. that the jaw itself has been resorbed where the space was closed or only the tooth is moved to cover that space?

I ask because it feels to me that I've lost both maxilla and mandible projection after extraction of four bicuspids and those spaces closed?

Regarding extractions, you lose the bone around the extraction site by the 6 month mark.
How much depends on how the roots of the other teeth are placed and biting forces (as mentioned, it stimulates bone)
If you pull your lip back and look at the extraction sites, you will probably see small indentations of missing bone where the roots used to be. Retracting the remaining teeth into that space shrinks the arches (i.e. because a tooth is much larger than the space needed to "fix" crowding). Tooth might be 10mm, but you only needed say 4mm to fix the crowding. Bad orthos will extract the tooth and retract. You lose that 6mm of arch. This is why extractions are devastating.

A root canal shouldn't result in bone loss so long as you can chew on the tooth. It will result in some gum recession, which they don't tell you about, if you put a porcelain crown on it. If it's a back tooth a gold crown is much more forgiving to gum tissue.

[tjarrr]

A root canal shouldn't result in bone loss so long as you can chew on the tooth. It will result in some gum recession, which they don't tell you about, if you put a porcelain crown on it. If it's a back tooth a gold crown is much more forgiving to gum tissue.

Yeah see I was worried about this - that the crown positioning and stuff might be less than ideal for exerting enough pressure and force. Like how would we know if it were enough biting force? Like as long as the upper and lower molar touch each other? (For a second I was worried because I thought I couldn't feel them touching, then I remembered I can't feel anything in the crowned tooth LOL.)   Would it have to be done over? And would the bone loss be in the alveolar process alone, or also in the jaw bone??

[Lazlo]

Regarding extractions, you lose the bone around the extraction side by the 6 month mark.
How much depends on how the roots of the other teeth are placed and biting forces (as mentioned, it stimulates bone)
If you pull your lip back and look at the extraction sites, you will probably see small indentations of missing bone where the roots used to be. Retracting the remaining teeth into that space shrinks the arches (i.e. because a tooth is much larger than the space needed to "fix" crowding). Tooth might be 10mm, but you only needed say 4mm to fix the crowding. Bad orthos will extract the tooth and retract. You lose that 6mm of arch. This is why extractions are devastating.

A root canal shouldn't result in bone loss so long as you can chew on the tooth. It will result in some gum recession, which they don't tell you about, if you put a porcelain crown on it. If it's a back tooth a gold crown is much more forgiving to gum tissue.

EXACTLY.

[GJ]

Yeah see I was worried about this - that the crown positioning and stuff might be less than ideal for exerting enough pressure and force. Like how would we know if it were enough biting force? Like as long as the upper and lower molar touch each other? (For a second I was worried because I thought I couldn't feel them touching, then I remembered I can't feel anything in the crowned tooth LOL.)   Would it have to be done over? And would the bone loss be in the alveolar process alone, or also in the jaw bone??

Even if the teeth don't touch it shouldn't result in bone loss so long as you stimulate that bone with chewing. Usually eating the normal 3 times per day is enough stimulation. Don't go purposely grinding or anything. You're worrying about it too much.

[tjarrr]

Ok guys, I have the radiograph image of the root canal tooth and the alveolar bone definitely looks like it's receding around where the root canal was done. I'm freaking out. I see what everyone's saying about there being enough biting force with the new tooth to prevent bone loss, but I think in my case the tooth was just not ideally positioned relative to the opposing maxillary wisdom tooth -- and it definitely looks like the bone is being resorbed and I think my jaw on the same side is getting smaller. What do I do?? Do I ask for a new root canal? Or a dental implant?