I would not pull that broken tooth. You are inviting a problem. I would do a gold post and crown. First endo is done on the tooth to remove the pulp chamber and the neurovascular bundle in the root that feeds the tooth from the primary above or below it with blood. Then the dentist will drill out a small receptor site down into the remaining portion of the tooth and root and make a direct pattern of it using a self-curing resin. This will be sent to a laboratory who will add some wax to the supragingival part of it making it a shape kind of like a crown prep on a natural tooth. Then you will revisit the dentist and he will cement this gold post into the root, and a crown can be made over the whole thing. Even though the tooth will be dead, it will be come ankelosed into the bone, with the fibers that normally hold it into place desiccating, and it will be safely and permanently there as long as you keep it clean and do not let periodontal disease creep in. All this circumvents an extraction that could lead to a non-healing socket due to lack of blood supply and micro vascularization

Guys and Gals,

Thanks for all of the information. I had the panoramic x-ray done last week. I have to go in for a consultaion before we decide on anything. This should occurr this week. I'll let "yunz" know what all of the medical professionals say. I've heard of the ORN before. My ENT explained it to me. And I will ask him to explain it again.

John

Hi Tom,

Osteoradionecrosis...bone that has received doses of radiation may lack the ability to repair itself after trauma. Radiation destroys the blood vessels in the area causing a reduction of circulation to the area of oxygen and other nutrients. This then will prevent normal healing in that area if the bone is injured.

Hyperbaric oxygen to the area will stimulate new blood vessel growth and therefore stimulate bone healing.

Without hyperbaric oxygen, removal of a tooth will probably result in bone that won't heal.

This is a good article: http://www.virginiamason.org/dbHyperbaricOxygen/sec181033.htm

I don't know about the relationship of IMRT radiation and ORN. sorry

Hope this has been helpful.

Jerry

Jerry,

Is ORN a permanent condition, or does it improve with the passage of time? Can ORN be detected by the panoramic x-ray?

John

Brian,

I definately agree with you and my philosophy is that it is almost always better to save a tooth than extract and replace it. This goes for any patient, with or without having been subjected to radiation.

As far as root canals, posts and crowns are concerned, in John's case if we assume that there is an option of saving the tooth i.e. there is enough tooth left to restore it and that endodontic treatment is possible, this would certainly be a better option than extraction.

Given that this is the case, after the root canal is completed, a post is placed in one of the canals. There are many types of posts, some of which are made in a laboratory and some of which are prefabricated and come in a kit. The crown can then be made by a dental technician after an impression is taken or the whole procedure, post and crown, can be made in the dental office with a CAD/CAM out of a block of porcelain. I've been doing crowns this new way for about 7 months and they have been very succesful.

Jerry

John,
You are not 'getting it'. ORN is a condition that probably will not go away and you can 'wind up with your leg bone in your jaw to correct it IF you are lucky'. Do these medical professionals normally treat patients that have had radiation? If not, you need to get a second opinion from some that do before you have this surgery. You need to be dealing with a surgical team that has experience with cancer patients. Reread Brian's reply or better yet, print it off and take it to your appointment.

Eileen

John,

I would be guessing but I think that once the blood vessels have been re-established, they will remain there. I'm not sure if a definite diagnosis of ORN can be made from a panoramic radiograph.

You might try doing a Google search for "osteoradionecrosis". There is a lot of information out there. That's where I got the link I used above.

Good luck and please let us know how you make out with the consult.

Jerry

Jerry,

I'll let you guys know as soon as I hear something. I have a lot of questions that I'll be asking at the consult. One thing I know for sure is that I have total trust in my ENT. If he told me to run into a wall, I'd do it. It's a comfort to me and my family to know that he'll be part of the decision making team. If I had any questions with any part of my treatment, be it chemo or radiation, I knew that I could always ask him. If he didn't know the answer, he'd find out or direct me to someone who did know the answer to my questions.

By the way where is Yardley, Pa.?

John

Yardley is in Bucks County, North East of Philly, across the river from Trenton, NJ.

Where are you?

John, here is a site that has more information. http://www.emedicine.com/ent/topic579.htm You don't want to take any chances with ORN. A while back, I had read that even Novocain shots can be enough injury to cause ORN to the already compromised bone. It is not the Novocain itself but the vaso-constricting drugs commonly mixed with the Novocain that stops the already slowed bloodflow.

All here, whom have had radiation to the jaw, need to be very careful about even minor injury to the jaw.