Many more people today understand the benefits of a dental implant. Before you have a tooth extracted in order to have an implant placed, you should consult an endodontist (root canal specialist). In many cases, a ‘condemned’ tooth can be saved by root canal treatment and restored to full use. Keeping original teeth is always preferable to inserting artificial ones.

This article is written by Dr Tony Druttman, MSc. B.SC. B.Ch.D, Specialist in Endodontics, based in the West End of London and the City of London.

A difficult choice

There’s no doubt that dental implants have been a major technological development in dentistry in recent years. Among the treatment options for replacing missing teeth, an implant is without doubt the first choice. However, when you have a compromised tooth, a decision must be made whether to save it or extract it. The decision is not always straightforward and can be complicated by a number of issues.

What is a compromised tooth?

The amount of tooth left that has not been destroyed by the ravages of decay and previous dentistry will be one of the most important determining factors. The tooth may have an infection or it may have a root filling that has failed to remove the infection. The tooth may be heavily restored with a post and a crown.

Your dentist may have suggested reasons why extraction is indicated:

  • the attempt to treat or re-treat the infection in your tooth may be too difficult
  • the work may be too time-consuming or unpredictable to be worthwhile
  • extracting the tooth and replacing it with an implant is the simpler and more predictable option

While these points appear to be sound advice, placing an implant is not always a straightforward as it may seem. With the right expertise and equipment, it may still be possible to save the tooth. After all, most people are keen to retain their natural teeth if they can.

The right approach is to have the various options clearly explained to you. Then you can make a choice from a position of knowledge.

What are your options?

It depends on the condition of the tooth. If there are many problems with it and little of the natural tooth material remains, the best option may be extraction. Trying to save it could be difficult, expensive and possibly weaken the tooth to the point where it could fracture during normal function at a later date.

However, if there is enough of the tooth remaining, then trying to save it could be very worthwhile. It may need root canal (endodontic) treatment or re-treatment. While such work may present a difficult challenge for a general practitioner, it is routinely undertaken by an endodontist, a specialist in root canal treatment.

Are there guarantees?

There are never any guarantees in dentistry, or for that matter in medicine. Both root canal treatments and implants have published success rates of over 90% when carried out by appropriately trained practitioners. If a root canal treatment does fail, it may be possible for it to be done again, using either surgical or non-surgical techniques before the tooth is removed. By contrast, if an implant fails, it has to be removed from the jaw, sometimes with valuable surrounding bone.

When a correct case assessment is carried out and treatment carried out to the highest standards, there is a very good chance of success with either treatment.

The difficulty with implants is in carefully planning the treatment. The dentist must assess the bone quality and quantity and know the exact position to place the implant. Sometimes if there is insufficient bone, then additional procedures may be required to augment the amount of bone. This adds to the time, complexity and cost of treatment. If the positioning is incorrect this may also complicate the treatment and potentially cause a severe aesthetic problem if the implant site is at the front of the mouth.

The planning for root canal treatment is not especially difficult, although a careful assessment has to be made. The treatment itself can be very challenging and may need special equipment such as an operating microscope to ensure the best chance of success. With the advances in technology and the establishment of Endodontics as a dental specialty, many teeth that were deemed hopeless can now be saved and restored to full function and aesthetics.

Does it come down to personal bias?

You may ask yourself: “Is it six of one and half-a-dozen of the other?” Depending on the experience and expertise of your dentist and the availability of specialist services, you may be drawn to one option rather than the other. The best advice, if you are in any doubt about the right questions to ask, is to get a second opinion from a recognized endodontist.

Sometimes it can be difficult to predict whether a tooth can be saved until it is investigated, and the outcome may not be certain. It can take several months before signs of healing are evident, so decisions have to be made with your own personal values in mind.


Implants vs. endodontics - questions to ask yourself

  • Do you want to try to save this tooth?
  • How will you feel if the attempt to save the tooth does not give you a positive outcome?

Implants vs. endodontics - questions to ask your dentist

  • Can my tooth be saved?
  • If you cannot save it, is there someone else who can?
  • How strong will it be after treatment?
  • What are the alternatives to saving the tooth?
  • Are there any complications associated with the alternative treatment?
  • What are the cost implications of the treatments available?

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