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ROOT CANAL TREATMENT OR TOOTH IMPLANT

Wearing a denture to replace missing teeth is no longer a desired option in the fast evolving modern society. Sometimes a tooth may be so severely damaged from tooth decay or trauma that the nerve of the tooth is dead or non-vital. Patients  and dentist are faced with this difficult decision , to save the tooth with root canal treatment and crown or just extract the tooth and replaced it with a tooth implant or dental implant.

Root canal  treatment and dental implant are both proven method of dental treatment with high success rate . Both treatment modality  are relatively complex treatment involving a lot of time and are more costly than dentures . So should you have a root canal treatment and crowning be done  or is it better to have a tooth implant instead.?

There are 6 instances whereby dental implants are preferred over root canal treatment and crowning.

1) Badly broken down tooth

Before opting for a root canal treatment the dentist have to decide whether the there is enough tooth structure after root canal treatment for crowning. Even with enough tooth structure for crowning, the dentist have to assess whether the final crown tooth is strong enough to withstand daily biting forces. One of the most common and heart breaking  failure mode of root canal treated tooth is root fracture. When root fracture occurs, the whole tooth has to be extracted and be replaced with a tooth implant instead.

The picture on the left shows  a molar that is badly broken down. There is not enough tooth structure for crowning and even if crowning  is done, root fracture is inevitable. In such cases, dental implant is the best option.

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2) Tooth fracture

Fracture lines that run across a tooth  is an good indication that a tooth is severely weaken . If the fracture line extends deep into the gum , the tooth is generally not restorable and has to be extracted and replaced with a dental implant instead.

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3) Root canals that cannot be treated

In order for a root canal treatment to be successful , the root canals in a tooth must be completely patent for cleaning and filling. If the  root canal are not patent for root canal treatment, bacterial will be left behind, setting stage for recurrence of infection and root canal failure.

Contraindications for root canal treatment

1) Broken  root canal instrument that are obstructive and cannot be retrieved.  The peri-apical xray on the left shows a broken root canal instrument in the root . Since the obstruction cause by the broken instrument  is preventing the cleaning  of the  apical region of the  root canal system , tooth extraction and replacement with a tooth implant is the next best option.

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4) Root fractures

Its not uncommon for heavily filled teeth to sustain microscopic fractures in the root . These microscopic fractures are often difficult to diagnose as they are not visible to the naked eye. Root canal treatment in tooth with root fractures has a very poor prognosis. This is because the constant ingress of bacterial through root fracture will    inevitable lead to root canal failure.

Root fractures are usually diagnosis with the help of operating microscope. The picture on the left  taken from our clinic operating microscope shows a microscopic fracture extending across a molar  tooth and into the root.

Treatment required : extraction of the fractured molar and tooth replacement with a dental implant

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5) Root Decay

Tooth with extensive root decay are not restorable. In other words, even if root canal treatment is done, due to the lack of tooth structure to retain and support a crown, failure will occur . Instead of spending considerable time and money  for root canal treatment and crowning, extraction of the bad tooth and replace with a  tooth implant ,is a better option as the prognosis is very much better.

The xray on the left shows an extensive root decay almost amputating the tooth crown from the root . In case like this, extraction of the tooth and replace it with a tooth implant or dental implant is the treatment of choice.

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6) Advance Gum Disease

One of the most question ask by patients with loose teeth due to gum disease is whether root canal treatment can save the tooth .

The answer is no because root canal treatment merely replaces an infected nerve and pulp tissues with a clean root filling material. It will not cure gum disease nor cause the bone supporting the loose tooth to grow back. Gum diseases is due to the loosening of tooth root attachment to the bone as a result of bacterial plaque on the tooth or root  external surfaces . Some patients are also genetically prone to bacterial  plaque induced gum disease.

The picture on the left shows a loose lateral and central incisors due to advance gum diseases and resulting bone lost. In such cases, root canal treatment is of  no use . The tooth should be  removed  as soon as possible so as to preserve as much jaw bone as possible for dental implants.

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