I had a crown a root canal and crown placed on #14. I have had complications due to an abscess caused by an unsuccessful root canal. I was told by two dentists that i would need a apexectomy to and a new crown which will cost over 2000. Apparently, there is no guarantee it will work. I'm thinking of getting an implant. Should i extract tooth or wait to see cosmetic doctor?
Do I Need to Wait to Extract Tooth Before Implant?
Doctor Answers (18)
Promoted Local Answer
Apicoectomy vs implant treatment
apicoectomy on tooth #14 is a very difficult and unpredictable procedure. The prognosis decreased significantly if a tooth has not responded to inital root canal and then retreatment (assuming it has been done). First I recommend you to see an endodontist to get their true opinion on the progosis. If it is poor (anything less than 90% success) then it is best to go with extraction and implant where you can have close to 100% success rate.
Endodontic retreatment vs implant
The multi-rooted posterior teeth have very little long-term success with endodontic retreatment. And they have extremely less predictable success with apexectomy due to the proximity of the maxillary sinus. If the tooth has a chronic abscess more and more bone is destroyed around the roots and less bone will be left for the future implant. Implant placement will be more predictable treatment in long-term than retreatment of questionable tooth with poor prognosis. Usually after the extraction of infected tooth the extraction socket is grafted with bone grafting material and covered with Collagen in order to preserve as more bone as possible after the extraction. After 2-3 month when the socket is completely healed the implant can be placed. You should get a consult with a specialist who will place the implant and restore it in order to discuss your options.
Apicoectomy or Extraction and Implant?
The problem you are describing is more common than you may think! The reason for this is that there is more than one reason why a Root Canal may fail in the area you are describing. Possible reasons for abscessmay include improper cleaning and shaping of the canal, poor apical seal or the failure to identify and treat an additional canal. If you have an abscess there is always a possibility of resolution with Endodontic Retreatment by a Specialist or Endodontist. If he or she can assess the tooth and make a good case to attempt retreatment that may be a viable option. In my opinion Apicoectomy does not have the greatest percentage with regard to long term certainty. I personally would opt to have the Extraction (with possible bone graft) Implant and Implant crown instead of the apicoectomy. To sum this up I would suggest you see an Endodontist to assess # 14 and if the prognosis is poor you should follow up with your Oral Surgeon and Restorative Dentist. I hope this helps you!
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Extractions, Laser, Bone Graft, Implants
1- See an experienced Endodontist that uses a microscope and get an opinion before you extract your tooth. If the Endodontist cannot give you a good prognosis, then seek the services of an experienced , laser trained Periodontist to evaluate you for an extraction, possible sinus graft/ bone graft and implant placement.The laser promotes rapid healing with minimal chances for post operative infections. You would also need a quality set of digital x rays for a full treatment plan.
Extraction and Implant or Retreat Old Root Canal
In my opinion, when a tooth gets to this point the best long term solution is to extract the tooth and place a dental implant. A dental implant is an artificial tooth root that is made of titanium and placed in the upper or lower jaw. Most of the time in this situation the tooth would be extracted and a bone graft placed in the extraction site. Four to five months of healing would occur, then a dental implant would be placed. The implant would heal for another four to five months before a crown could be attached to it. In some cases, an immediate placement can be done. This is when the implant is placed at the same time that the tooth is extracted. Good luck.
Do I Need to Wait to Extract Tooth Before Implant?
This is a fairly common scenario that we run into on a daily basis . We need to consider if it makes sense to try to save this tooth . If it's easy to see why the root canal is failing that it may make sense to redo the root canal .
If the root canal seems to been done well and there's no obvious reason why it is failing, then an implant may make better sense .
If the infection has destroyed a significant amount of bone then a bone graft may be required. This may be done as a separate procedure prior to placement, or it may be done at the time of implant placement.
Hope that this helps
Extractions and dental implants
A failed root canal is not uncommon. In the past, an apexectomy was a common procedure to salvage the tooth and if that procedure failed, the tooth was extracted and a bridge was then manufactured to replace the missing tooth. Implants add another option to replace a failed tooth. If you look at the long-term aspect, implants are the logical solution. Apexectomies, especially on a multi-rooted tooth, are not a guaranteed to succeed. Replacing the missing tooth with a bridge, compromises the teeth that the bridge is anchored to, resulting in further treatment. Implants do not damage adjacent teeth and offer a long- term result to replace missing dentition. However, implants need to be placed in bone, so if a tooth has a chronic infection, bone damage has likely occurred. A bone graft may have to placed to preserve the height or width of the implant site during or after the extraction procedure. After a period of healing, an implant can be placed to replace the missing tooth
You can extract the tooth and have the implant placed right away.This is the best case scenerio.
However , we have to check the ct scan to see if you have enough bone to place the implant,If not,we will have to extract the tooth,place the bone graft and wait for 4 to 6 months.
Than you can have the implant placed.
Apicoectomy is usually accompanied with a guarded prognosis. Meaning it will not have a long term resullt even if it takes !
Implants are mor eof a sure thing, but if your tooth is abcessed, you need to extract it ASAP, because th einfection can deteriorate the bone and make p[lacement of the implant more complicated or lengthier than usual. Having said that, you do not have time to wait to replace the area becuase teeth shift very quickly.
There is no Simple Answer!
Since we are talking about tooth #14, a major concern is where you sinus floor is. Often in this area there is not enough bone below the floor of the sinus to place an implant without a sinus lift procedure. This will delay treatment and significantly increase the cost.
Discuss this completely with your dentist before making a final decision so you can make an intelligent decision.