Root Canals vs Implant
You’ve probably heard that root canals can save teeth so they don’t have to be replaced, right? Like many things in life, there’s more to it than appears at first glance.
If you have a painful tooth, and you go to your dentist and the diagnosis is that the pain is caused by a cavity that has finally decayed so deeply that it has entered the nerve deep inside the tooth. And pain, due to infection, is the result. Why not go on antibiotics then? Certainly, but as long as the nerve chamber has been compromised, antibiotics won’t “do the trick” all by themselves. At that point, a root canal is proposed by your dentist.
What is a root canal, exactly? The tooth is drilled-into, to open the pulp chamber where the nerves and blood vessels are, deep inside the tooth. Various metal instruments are used to scrape-out those contents, then it is irrigated often with bleach, then the chamber and down into the roots themselves, are filled with a plastic-like substance. This renders the tooth clean and since the nerves are gone, you no longer feel pain. And you still keep your tooth.
Is that the end of the story? Sometimes.
The dentist tells you that because the tooth had a root canal, it needs to be protected by a full crown. Why? The protection is required because what you’re often not told is the tooth now has become lifeless and will become very brittle, and subject to cracking and fracturing. Like a dried-out twig on a tree. Sure the recommended crown will protect the top part of the tooth, but what about the roots of that dried-out tooth? Nope! There’s no protection for them from the crown on top.
Over time, as the tooth becomes more and more brittle, and assuming you’re chewing on it, a crack or fracture can result. Don’t worry, you won’t feel it fracture. But do worry because it will lead to a painful infection and even a bone-dissolving abscess.
In the early stages of that problem, you’ll probably notice a small, pea-sized swelling on the cheek side of the tooth, right at the gum line, when you’re brushing your teeth. Antibiotics again can alleviate the pain but not cure the problem. A “re-treatment” of the root canal won’t fix a fractured root. Nothing will. The tooth will have to be removed.
Yes, the extraction site can be utilized for an implant to replace that failed, root canal treated tooth, but sometimes additional procedures have to be done, prior to implant placement, depending upon how much bone was dissolved by the infection.
Are root canals a failure waiting to happen? They are not!
Root canals are not necessarily a failure waiting to happen. However, patients should hear all the pluses and minuses about all their treatment options, and the long term success rates of each.
First of all, do root canals work? Yes, they can. If root canals are done by a root canal specialist, an endodontist, they have a higher success rate, over-all, than if done by a family dentist who only does root canals occasionally. Choose wisely.
An endodontist is an American Dental Association accepted specialty. Those who wish to become endodontists have to take extra years of training to become a specialist, which are not part of a family dentist’s education.
However, if you were to look into the training programs for this specialty, you’ll notice one area of education which seems initially out of place. The specialty training includes how to place dental implants when root canals fail. And, is that failure rate backed-up by scientific studies? Yes, it is.
When making your decision – a root canal vs implant – consider if you’re picking a short-term or long-term solution.
The research focused on tooth treatments.
A few years ago, the Academy of Osseointegration undertook a review of all pertinent scientific studies in dentistry that focused on tooth treatments. The head of the committee was the Chairman of an Endodontic specialty training program, who obviously is in favor of root canals. The committee reviewed all of the scientific studies on how successful root canal treatments are and how long they last.
A summary of the findings are these: Yes, root canals can work. And, if they are done perfectly, they last equally well as implants which replace missing teeth, for up to 5 years. After that time, implants were shown to have a longer lasting success rate as some of the root canal treated teeth began to fail, often due to root fractures, as discussed previously.
They compared the success rate of root canal treated teeth when they needed a “re-treatment,” to the success rate of dental implants. The “re-treatment” teeth were not as successful as dental implants, per the scientific studies. These results were published in the world’s most acclaimed scientific journal regarding implants, the International Journal of Oral & Maxillofacial Implants.
How do I decide – root canal vs implant?
What is the best decision for me? Do I get a root canal or a dental implant?
Here is a good approach for any patient to take in deciding what to do with a problem tooth.
- Meet with your trusted family dentist. Ask them to evaluate your tooth problem. Then ask what needs to be done for that problem tooth.
- If there are any alternatives, what are the advantages and disadvantages of each alternative? Then ask if you were to do what the dentist is recommending, what would that treatment cost?
- Ask if you were to go forward with that treatment, how long might that tooth be “good for?” Of course, no dentist can guarantee in writing how long a treated tooth will last, but ask anyway. What you really want to know is this- might that tooth last only a few months or just a few years, due to other problems with that tooth, such as bone loss due to gum disease, or does the dentist believe the treated tooth is likely to last for many years, perhaps decades? There’s a big difference.
- If it costs a lot to save a tooth and it isn’t likely to last anyway, then replace the tooth with a highly predictable dental implant, as a better long-term choice and you’ll get more “bites” per dollar invested!
If you have any doubts about a problem tooth or teeth, come see us for a second opinion.