Root Canal or Extraction and Dental Implant?

I am often asked by my patients what the best treatment option is when a tooth is at risk - a root canal or a tooth extraction and dental implant.

As an Endodontist who does both, I will tell you that it is always best to try and save the natural tooth (via root canal), and if you can't, then it is generally best to extract that tooth, preserve the socket with bone graft, and after a healing period, to place a dental implant and a restorative crown.  By focusing on the tooth at risk, you will avoid damaging adjacent teeth with dental bridges (however sometimes a bridge may be a good option).  Let me explain.

When my office phone rings, it is usually a dentist calling with a questionable tooth.  Can the tooth be saved?  The majority of the time, the crown of the tooth is decayed or we see a cracked tooth below the gum line.  In severe cases, the decay has penetrated beyond the enamel and dentin and into the pulp of the tooth (the portion that is "alive" with blood flow).  

At this point, I have to determine if I can remove the root of the tooth and keep the tooth structure, filling the root and capping the tooth with a dental crown.  It is a complex process, which requires the use of a dental microscope and advanced dental instruments.  But not every tooth can be saved. 

Thanks to modern advances in dental technology, we can extract a failed tooth and fill the socket with regenerative material and replace the missing tooth with a dental implant.

Bone grafting is done at the time the failed tooth is extracted.  Based on the surrounding bone and tissue, the healing process takes anywhere from 4-12 weeks.  Bone grafting is statistically effective in preparing the tooth area for a dental implant.  In some cases, the dental implant can be placed with or without bone grafting at the time the tooth is extracted.

Once the bone has been prepared, the dental implant can be placed.  Varying sizes of dental implants allow for placement in most areas of the mouth.  The process time for dental implant placement includes three visits over a period of 3-6 months.

This includes dental imaging, tooth extraction and bone grafting, the placement of the dental implant , healing time, and the placement of the dental crown.

A good dentist will be in direct contact with the specialist performing the procedure - to ensure maximum results.  In some cases both the dentist and the specialist (Endodontist, Periodontist, Prosthodontist) are in the same practice, but not always.

When having a root canal performed, a tooth extracted, bone grafted, a dental implant placed, all with an esthetic crown, it is worth searching out the best dentist in town, even if it costs a little bit more than you may expect.

And for those of you who are a little nervous about treatment, ask Dr. Steuer or your dentist about sedation dentistry.  Most dental offices will offer some form of sedation dentistry to calm the nerves, ranging from nitrous oxide to conscious oral sedation.

Now that you have made it this far, I would hope you walk away with the following lasting impressions:

• Root canals preserve the natural tooth
• Dental implants replace missing teeth naturally
• Sedation dentistry is a good thing
• Better doctors have longer lasting results - saving you money over time - so select your dentist wisely

 

If you have questions, give us a call at (207) 879-0010.

And lastly, love your dentist, and love your smile!

By David R. Steuer, DMD, MMSc.
Endodontics, Implantology, and Dental Surgery
www.dsofmaine.com


Dr. David R. Steuer received his Certificate of Endodontics from the Harvard School of Dental Medicine and his Doctor of Dental Medicine from the University of Louisville School of Dental Medicine.  Dr. Steuer is a noted lecturer on the topics of Endodontics and Implantology.  He is the Managning Partner of Dental Specialists of Maine with locations in Portland, ME, Yarmouth, ME, and Biddeford, ME.