Cavities between the teeth Again

Six to seven years ago, Mr. Logan had two fillings between molar and premolar teeth (Fig.1: F).  The corresponding molar on the top was missing (Fig.1,2: *).  The top premolar probably exerts a wedge effect, pushing food into the space between the bottom teeth (Fig.1,2: arrowhead).  It is also possibly due to the fact that he does not floss, he has now two new cavities between the bottom teeth, under the old fillings (Fig.3: *)!  The cavity in the premolar is a little far away from the nerve (v), while the cavity in the molar invade the nerve (>).  The latter causes so severe pain that root canal gets started (Fig.4 black arrowheads; white arrowheads indicate the root tips).  After the cavity in the premolar is removed and prepared (Fig.4: P), the nerve (v) is not encroached.  A new filling is placed for the premolar (Fig.5: F).  Finally root canal is finished for the molar.  Filling is placed to the root tips (Fig.5 >, as compared to Fig.4).  In the end, a crown is placed on the bottom molar.  To prevent cavity from coming back again, an implant should be placed on the top molar (Fig.2 black box).  Flossing is also required.

Xin Wei, DDS, PhD, MS 1st edition 07/14/2013, last revision 07/14/2013