Problem Teeth - Root Canal vs Extraction and Dental Implant

Many decades ago, patients were encouraged to consider extraction as a long-term solution to problem teeth, but this philosophy has been considered out-of-date for 50 years or more.

These days dentists would prefer to do anything to help their patients hang on to their own teeth for as long as possible! We have also become aware of what happens if we just leave a space instead of replacing the extracted tooth (something we discussed in a previous blog). 

Obviously, the consequences of an extraction depend on the tooth in question. When it comes to problem teeth, losing a lower back tooth will be a lot less traumatic for most patients than an upper front one, due to the major change in appearance.

However, losing a tooth in any position may significantly affect your occlusion or bite. Most patients will adapt and manage to retain a normal diet if they lose one or several of their molars, but if there are multiple spaces, overall function can become a problem.

In addition, biting forces may not be distributed evenly between the remaining teeth causing these teeth to have more wear and tear and suffer from sensitivity when biting. This can lead to chipping or fracture and increased mobility.

The loss of even a single opposing tooth may mean over time that the tooth directly below or above the space can grow into the space and become unstable. This may even – in worst-case scenarios – result in the eventual loss of this tooth as well. 

As teeth drift, spaces will open between them and these can trap food, making it difficult to maintain effective oral hygiene and lead to problems of dental decay and gum disease. 

Given all the potential consequences of tooth loss, it makes sense that the final decision to extract or try to keep the tooth should be considered carefully. If deciding to extract, then dental implants are a popular option to replace the tooth with a natural-looking alternative.

An implant not only improves aesthetics but also maintains the other teeth in their correct position with even distribution of force and harmony in function.

Of course, the final decision is down to the patient and there are many factors to consider. The three most common influential factors are cost, time of treatment and prognosis.

Cost

These days implants are a very popular and readily available treatment option. However, at first glance, they may still appear to be less economic than trying to save your own tooth. 

However, do be sure that you have a full estimate of what´s involved when trying to keep your problem tooth, which might otherwise be extracted.

Often these badly broken down/decayed teeth require a root canal treatment as the decay has now spread to the centre of the tooth where the pulp (nerves and blood vessels of the tooth) are found.

Once this has been done, the tooth structure remains very weak and may need to be built up with a large filling or more commonly a crown. 

There is often minimal difference between this series of restorative procedures and the extraction and straightforward placement of an implant and crown. 

Treatment Time

As with all things clinical, this varies from case to case. Generally though, both the restorative treatment (root canal, crown) and the implant procedure will require multiple visits over a period of time.

However, you might be surprised to know that the surgical stage of placing an implant often takes far less time than performing a root canal treatment on a back tooth. But implants must be allowed to heal and integrate with the surrounding tissues and this can often take several months to occur. 

Despite many advances in treatment protocols, this healing period is still essential although during this time you may have a temporary in place.

In contrast, the time from start to finish of completing the restorative treatment to save your own tooth doesn’t usually require any set healing time in between and hence can be completed much faster.

Prognosis

Again, this depends on what state the problem tooth is in. Front teeth are easier to access and treat and have single root canal systems so there is a higher success rate than when we are working on back teeth with complicated, multiple root canal systems. 

Modern techniques have resulted in a far better chance of retaining the tooth for many years, however, it does depend on who performs the treatment. An endodontist (root canal specialist) typically enjoys a success rate of around 95-98%, whereas studies indicate that for a general practitioner it is around 80-85%.

Unfortunately, in nature, nothing carries a total guarantee and if you are unlucky enough to be in the small percentage that does not succeed then extraction and implant placement may be needed.

It’s important to realise, though, that even if all goes to plan, you probably will not keep that tooth for your lifetime. The weakened nature of the tooth plus the possibility of reinfection may mean you have anywhere between a couple of years to around 10 years in good scenarios. So some might say you may just be prolonging that final extraction.

Implants, on the other hand, are more predictable in their success rate and, provided all factors are favourable once they have successfully integrated and they are well maintained, should last a lifetime.

The overlying crown may need to be replaced (just like any other dental work in your mouth subject to biting forces over time) but the root of the implant should remain healthy.

Keen to know what the best option is for your problem tooth? Why not make an appointment for a free consultation? 

Contact Ocean Dental Marbella on (+34) 951 77 55 18 or email dentalclinic.oceanclinic@gmail.com