Failed Root Canal with Chronic Abscess. Re-treatment or Abstraction and Implant? (photo)

Maxillary First molars statistically have the highest failure rate after endondontics of any tooth in the mouth. If a conventional root canal fails on the Mx first molar; I counsel my patients to extract the tooth, graft bone in the socket and then proceed with implant and restoration after 3-4 months. Time is critical after the extraction as bone that is not stimulated will atrophy and possibly require additional procedures to buttress bone prior to implant placement.

If it were my own mouth, I would prefer the EXTRACTION, followed by an implant. Much better odds than retreating a failed Root Canal. Have an experienced Implant Surgeon do the extraction, so as to preserve and maintain healthy bone for the implant. A year is probably OK to wait AFTER the extraction. DO NOT LEAVE THE UNTREATED ABSCESS!

Most of the latest research points to a higher predictability of success with the extraction and dental implant placement. If this tooth was part of a bridge or another circumstance, I might recommend the root canal retreatment first, as there are other logistical concerns prior to an implant placement. However based on your circumstance, the extraction and dental implant, is a better long term solution. Your dentist can review the various options for temporization to avoid being "toothless" while the implant is placed and integrating in the bone. Hope this helps.

I would get the opinion of an excellent endodontist if you have not already and ask his or her opinion of the success of redoing the root canal.  A photo really does not show what is wrong with the existing root canal and how salvagable it may be.  If they can not give you a very high degree of success, I would go ahead and go the extraction and implant route.

Root canal treatment is a very successful treatment but sometimes it fails.  The subsequent re treatment has a lower success rate than the original treatment and involved time and money with a prognosis that is not best.  Also because of the chronic abscess there is likely bone damage which around a tooth can't be readily repaired.

An implant has a high success rate and done correctly a very good prognosis.  If there is sufficient bone there is a good chance that an implant can be placed the same day the tooth is removed and a bone graft is placed around it.  This would heal for 4-6 months.  So no time going "toothless".  If an immediate implant is not possible then something temporary can be made, or just walk toothless its a back tooth :_).

 

Hope this helps.

The prognosis of this tooth is poor. So, basically no matter how efficient will be the re-treatment- chances of this tooth to stay for the next 5 years are non-visible. So, the best option in this situation is to extract the tooth, remove all the infection in the area, graft the socket, wait 3 months and than get an implant. Probably you will be without a tooth 6-9 months, depending on the amount of the damage of the bone from this infection and proximity of the sinus.

This is an easy recommendation.  I would go with the implant.  Apico's really only have a 50% L-T success rate.  Implant success rates approach 99% for most competent clinicians.  Be sure to ask your implant dentist hie or her success rate.  You could very well do the apico spend thousands of dollars and have to replace it with an implant.