Dental Education Lecture: It is Never Too Old to Heal

Fig.1 Before Treatment

Fig.2 Immediately After

Fig.3 Four Months After

Fig.4 Ten Months After

Fig.5 Two Years Five Months After

Two years ago, a 69-year-old lady came to my office with a request to save a loose tooth.  Thirty years ago, she lost four of upper front teeth in an accident.  She has worn an upper partial (denture) since. Exam shows that a lower front tooth was quite loose due to severe loss of bone around it (* Fig.1).  Three arrows indicate the extent of bone loss.  It seems that the tooth is difficult to save.  Extraction of the loose tooth and making a lower partial is the first option for her.  To her, the lower loose tooth is so small, whereas the lower partial would be so big and uncomfortable.  She would prefer to save the tooth.

All-around exam shows that the loose tooth is dead.  It appears that the nerve of the tooth was traumatized in the accident 30 years ago.  Root canal treatment (to take out the dead nerve) is the most suitable therapy.  Due to the extent of damage, the result is not guaranteed.  The lady agreed to take a chance.  

Fig.2 shows X-ray immediately after root canal (arrow) and once again shows the extent of the bone loss around the tooth.  Four months later, the patient returned to the clinic for cleaning.  She felt that the tooth was not so loose.   A new X-ray was taken.  The density of bone around the tooth was increased (Fig.3).  The density was further increased in another six months (Fig.4).  Two years and five months after root canal, the density of bone around the tooth appears to return to normal level (Fig.5).  This senior is quite pleased with the result.  She does not care about slight mobility of this tooth and neighbors. The slight mobility of the lower front teeth is due to the fact bone loss in the vertical dimension.  The red line in Fig.5 indicates the bone level at present, whereas the green line estimates the bone level when she was at her twenties and before the accident.  The loss of bone in the vertical dimension is usually due to the fact that we do not practice good personal oral hygiene and that we do not have regular professional cleaning over long time.  

Xin Wei, DDS, PhD, MS 1st edition 05/26/2009, last revision 07/21/2011