Chronic sprained tooth syndrome (over 3 years!) - how to fix?

[sunsetconnection]

Hello,

I was headbutted to my front teeth over 3 years ago and clenched very hard so my #4 tooth (third tooth from the left on the xrays) started to hurt, it was adjusted a few times and pain on and off but the bite now is too high so the jaw is clenching on that side. Sinuses are starting to act us and the pain feels like inflammation now across the top teeth. Root canal was suggested along with crown and build up of the neighboring teeth but will that help with the tooth ligament injury? It looks like there is a bone loss around that tooth and inflammation in the sinuses as well as thickening ligament. I have not idea what to do since nobody can tell me that the treatment will help. The pain is driving me crazy...thank you!

 

[Gordon]

Really would need a lot more information before I could begin to guess at what's going on.

Have you tried a bite guard at all?

 

[sunsetconnection]

Thank you, Gordon, yes, I have been using mouth guard at night and it does help with easing the pain. But then it gets bad during the day as I talk, eat, and the teeth are trying to rest/touch. Ibuprofen relieves the pain, but I cannot take it all the time. I had an iTero scan that showed how the 2 premolars and molar on the top right don't touch with the cusps on the inside of the of mouth (only touch with the cusps on the outside), so the theory is that the teeth move when I bite down and the ligaments are aggravated specially on #4. Also #4 hurts when I press down on it but it's not sensitive to cold or hot. Also, its location close to the sinuses doesn't help. There is definitely more gum recession, bone loss and inflammation in the sinuses now compared to 3 years ago on tooth #4. A prosthodontist suggested a crown on #4 and composite fillings to build up the cusps on the first premolar and first molar. All three teeth have deep white fillings from probably 10 years ago. I am worried that both the root canal and crown would aggravate the ligament even more on #4. I am also worried how the composite built up will affect the adjacent teeth #3&5 - I don't want them to be traumatized and die but they are being traumatized every day now with the uneven bite. Thank you so much for reading.

 

[Gordon]

Trouble is, as you lose bone you also lose support for the teeth so that makes the job of the remaining periodontal ligaments harder, you also have a bit more leverage against the root as the support moves more towards the apex.
The prosthodontist's approach sounds like it makes sense, but it might be worth asking an orthodontist if there's a less invasive solution?
Again I don't know enough of your background information here (and I don't think it's appropriate for you to post it all in public!) so take my advice with a large spoonful of sodium chloride...

 

[sunsetconnection]

Thank you, Gordon! Do you think the tooth #4 needs root canal before crowning it? The endodontist suggested that (of course) but the prosthodontist said we could just first crown it... but since it always hurts, I am skeptical that would miraculously stop hurting with the crown.

 

[Gordon]

I would want to do an electronic pulp test on it before crowning it, to check how healthy the pulp is before crown, if it was OK then go ahead and do the crown.