Dentistry/Root Canal

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Question
Hi Doctor,


I am all confused about a root canal or maybe getting a dental implant. I have a bad filling in a lower tooth. It is just behind my left eyetooth. Its all messed up and has a old deep filling.  My dentist in Atlanta said to do root canal. I just moved back to Michigan.  My new dentist is really young. He wants to pull it and install a dental implant. He says root canals is old fashioned. He says they will fail. He says to just do a dental implant. I have new insurance but its still more expensive. I was thinking about calling my old dentist. Do you have any advise?

Answer

  

Lakeesha,


Thanks for sending in this question.



Over the last 20 years there has been an increase in the use of dental implants for the replacement of missing teeth. Your question is asked by a lot of patients who often see ads on television .  They hear through their friends and media about replacement of teeth through implants.


Traditionally, root canals have one of the highest rates of success and long term outcome of any dental procedure. There are numerous long term scientific studies which demonstrate over 30 year plus outcomes with properly performed root canal therapy . A recent study done by the Delta Dental Plan in California tracked many thousands of teeth treated with root canals. The procedures overall  had over a 95% success rate. The main cause for failure of these treated teeth was due to leakage  meaning not getting the tooth properly restored with a "cap" or crown.


Dental implants do retain an important place in patient care in select situations. They are very useful and can be a great adjunct in patient care. However, before a patient can undergo any type of therapy, a thorough medical history is essential. I presume you do not have any compromising medical conditions that can affect  your bodyís  ability to heal. This is very important when considering any treatment, but specifically in your case of deciding between a root canal and a dental implant.


When considering any type of treatment the following issues are important in determining the exact nature of therapy. What is the long term outcome? What are the patientís needs and concerns. These can include, aesthetics, occlusion (biting & chewing ability), as well as social and financial issues. Furthermore,  in formulating a treatment plan, the dentist should evaluate the restorative , periodontal (gum condition and supporting bone) , as well as the endodontic (root canal) status.  This may include root curvatures, calcification's, number and shape of canals, accessibility etc.


Without knowing your medical history, your current  medications, or the results of a recent  radiographic and clinical examination,  itís very difficult to determine your best course of treatment.  However, if your medical condition is not a contraindication, and the " lower bicuspid" tooth behind the eye tooth is periodontally  healthy, then the previous filling and any decay  can be removed so there is adequate tooth structure  to restore the tooth with a "cap" or crown.



If you have a periodontally healthy situation, then  endodontic therapy is the best and cheapest way to treat your case. However, it is essential that after the root canal is performed, that the tooth be restored properly. Insurance companies will pay for a "cap" or crown on a root canal treated tooth.


This approach will provide you with the most conservative  and least costly treatment with a very high degree of success. Also, if many years from now, for some reason the tooth developed severe periodontal (gum) disease,  recurrent decay, or is fractured, and an extraction becomes necessary, you would STILL have the option of implant placement.


It should be noted that if you went with the implant instead of the root canal, it would require a surgical procedure including extraction, possible grafting bone, and surgical placement of the implant. Once that heals you would be required to place a crown (cap) on the implant. You also would need to be super conscientious about your gum and periodontal care. Periodontal and gum pockets often develop after implants and are a major potential source of failure. In addition, placement of an implant in the mandibular bicuspid area is not without risk. There is a major sensory nerve branch that exits out of the lower mandible  sometimes near the root tip of the bicuspid roots.  This can be easily damaged during surgery and could result in permanent parathesia  (numbness).  



Lakeesha, I  appreciate the opportunity to answer such an important question. If your new dentist refuses to consider a root canal option, seek a second opinion from a Board Certified  Endodontist. That is, a root canal specialist.  Also,  by all means check with your former general dentist in Atlanta.



Sincerely,



Robert Block, DDS

Diplomate,  American Board of Endodontics  

Dentistry

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robert block

Expertise

I would prefer to answer questions related in my specialty of Endodontics( ROOT CANAL THERAPY) I am a Board Certified Endodontist with a special interest in advanced surgical endodontic procedures. I know root canals create a lot of apprehension in patients, and they usually have many questions about the procedure. I can address patient concerns either before or after their root canal treatment. I also have re-treated numerous patients who have had previous endodontic treatment. As a result of these clinical failures,and the increase in the use of dental implants, its important patients understand the alternatives of therapy. There are often many components to treatment that interrelate the disciplines of endodontics, periodontics and restorative dentistry.Patients frequently question the importance of considering all facets in a clinical regimen. Hopefully, I would be able to educate and contribute some information from the endodontic perspective.

Experience

Diplomate American Board of Endodontics, 35 years plus private practice experience. Formerly Professor and Chairman, Department of Endodontics at US dental school. Editorial journal reviewer for the endodontic section of The Journal of American Dental Association. Serve as a reviewer on several editorial boards.

Organizations
American Association of Endodontists, College of Diplomates, American Board of Endodontics

Publications
Over 150 publications, abstracts, case reports, chapters in textbooks. J. Dental Research, J. of Endodontics, J. of Oral Surgery Oral Medicine Oral Pathology,The NEXTDDS J.For example: The Single File Approach for Predictable Endodontic Canal Instrumentation:The Wave One, THE NEXTDDS J. 4-2:13-17 Fall 2014 Non Surgical Management of an Endodontic Failure Utilizing Contemporary Technology, www.THENEXTDDS 5-1:60-63 Spring 2015 Are You Still Using Formocresol? An Update, Tn. Dent. J. 89-4:14-19 Fall 2009 Management of Endodontic Failures, Oral Surg.vol.66:711-Dec.1988

Education/Credentials
BA. DePauw University, DDS. University of Michigan, MS. Medical College of Virginia, Virginia Commonwealth University, Gen. Practice Resident, University of Connecticut, Endodontic Resident Medical College of Virginia, Virginia Commonwealth University

Awards and Honors
Numerous Awards and Honors, Edward P. Hatton Award( Int. Assoc. of Dental Research), Endodontic Memorial Research Award ( American Association of Endodontics) Outstanding Endodontic Department Teaching Award (given by dental students)Fellow American Academy of Dental Science

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