The 2009 root canal failed due to the ill-fitting crown and I now have a chronic abscess deep in the former root near my sinus. (Gum boil visible in photo). Should I attempt to save the tooth through re-treatment and a new crown or move straight on to abstraction and implant? What is the max amount of time you can go "toothless" before having an implant? Is a year too long?
Failed Root Canal with Chronic Abscess. Re-treatment or Abstraction and Implant? (photo)
Doctor Answers 6
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.
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!
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.
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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.
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.
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.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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