With the advent of the implant are root canals a thing of the past? What are Endodontists saying about this??
Why Get a Root Canal if You Can Get an Implant?
Doctor Answers (12)
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Dental implant or root canal
If a tooth has a very good prognosis by performing a root canal and a proper restoration, then it should be the treatment of choice. If the prognosis is poor or it requires significant number of procedures to save and there are structural compromises, then extraction followed by implant should be considered as the treatment of choice. When appropriate, and performed by skillful endodontists, root canals can be very successful. It is best to do predictable dentistry, and not heroic dentistry.
Endodontic treatment vs dental implant
Root canal therapy still exists and is a predictable treatment for the teeth with good bone support, enough of remaining tooth structure and when saving the tooth is important for occlusion. If the situation with the tooth is compromised, it is severely decayed, has periapical changes and periodontal disease - dental implant becomes more predictable option. Usually before considering the endodontic treatment and invseting the money in it the patient should ask his dentist about all possible risks and benefits, get the information about the overall tooth prognosis. Opened and clear communication between the patient and the doctor is essential in choosing right type of treatment.
Implants vs Root Canal
Your question is a good one. It all comes down to predictablility. In the past, dentists did everything they could to save a tooth but with the advent of dental implants that has changed. No dentist likes to extract a tooth unecessarily. If a tooth is in need of a root canal and has good bone support and adequate tooth structure remaining to restore the tooth then I feel that root canal therapy is appropriate. However, if the tooth is compromised, has a failing root canal or requires a heroic effort to restore, then consideration must be given to the implant since its success rate, in that case, is more predictable. Be sure to discuss all of your options with your dentist before making any decisions.
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Dental Implant or Root Canal?
As dentist we always try to be as conservative as possible when performing treatment. A root canal is the most conservative treatment the majority of the time. Root canals have well over a 90 percent success rate and are many times a wise choice of treatment. In cases where a tooth would require a post and core or the retreatment of a past root canal, it is my opinion that a dental implant would give a better long term prognosis. There is a place and time for both of these procedures and a well trained dentist will always discuss the pros and cons with you of your particular situation.
Believe it or not there are more and more Endodontists ( root canal specialists) who are placing dental implants. Why? Because they can be very good judges of when a tooth is not worth saving and are a very trusted colleagues of the many dentists who are not comfortable with dental implants.
I am a general dentist who has been placing and restoring dental implants for nearly 30 years. I also do many root canals on a daily basis but sometimes a judgment call based on experience needs to be made as to the long term prognosis for a tooth. If the tooth is either too broken down, periodontally involved or the root canal faces being retreated, a dental implant may be the better choice.
If you can save a stable tooth, do it!
Even though implants are an extremely successful treatment option I would recommend you try and save your tooth with a root canal assuming that the dentist thinks that the prognosis of the tooth is favorable. Maintaining what you have is the more conservative approach.
A good tooth is still the best.
Let me start by saying that I am a fan of both root canal treatment to save teeth and implant treatment to replace missing or hopeless teeth. Some teeth cannot be saved. They may have a root fracture, or decay that makes them unrestorable, or maybe they are periodontally involved to the point that there is not enough bone to hold the roots in place.
If however there is enough good healthy tooth structure remaining I feel that nothing is as good as a good tooth. Teeth are anchored in the jaw bone by roots which are attached by a ligament. This periodontal ligament acts as a shock absorber of sorts for your teeth. It also contains nerves which feedback information when you are chewing so you will know if you are chewing too hard or not hard enough, ... this is called proprioception.
Implants are fused to the bone in a process called osseointegration. There are no nerve endings or ligament around an implant to give you that information.
This is the main reason that I like teeth and recommend root canal treatment over implants whenever it is possible.
Your own tooth is worth saving
As a general dentist who both performs root canals and places dental implants I have a unique perspective. I always try to save teeth. I think there’s nothing better than having your own teeth. A root canal is a fairly routine and painless procedure. The dental crown can be placed several weeks after your root canal and the work can last for many years.
Implants are terrific but they do require a bit more work. You may have to wait ~4 months for the bone to heal after taking a tooth out, and then another 4 months before a crown can be placed on the implant. Although dental implants are painless, they do require a minor surgery of first taking the tooth out and then placing a dental implant into bone. I advise my patients to avoid any surgery unless it’s absolutely necessary.
Although dental implants are highly successful , studies show ~96% of the time, sometimes they do fail. In which case they need to be replaced, which uses up more of your time and possibly incurs more expense.
Of course there comes a point where it’s no longer worthwhile to save a tooth, in which case dental implants are a terrific option. I always give my patients all the options. But I advise them to do what’s easiest, least expensive, and most predictable. Good Luck!
Why get a root canal when implants exist
My feeling is to always do the most conservative treatment possible after weighing all the pros and cons. If the prognosis of a tooth after doing a root canal is poor then a dental implant may be the better alternative before attempting the root canal procedure. I see many times root canals performed on teeth that should have been extracted because the prognosis of a crown and post is guarded.. I personally would never extract a tooth without trying a root canal first unless the very little tooth structure remains.
If the tooth is truly salvageable, it may be a more conservative approach.
Implants have not become substitutes for root canals. Yes, there may be a very fine line at times between one versus the other, thus a good and professional evaluation is absolutely necessary prior to proceeding.
Anca Bazile, DDS, MSD Periodontist, New York City