As an endodontist, I am a dental specialist responsible for root canal (or endodontic) treatment. We endodontists are often faced with the dilemma of deciding whether a damaged or diseased tooth is worth saving with root canal treatment together with a restoration such as an onlay or crown, or if it would be better to extract and replace it with an implant.
It must be said that, in this day and age, both treatment modalities are believed to have about a 95 per cent to 96 per cent long-term success rate. As a profession, we are very lucky to have two such well-established treatment choices for management of an infected or broken-down tooth.
There are a number of factors that root canal therapists need to take into account before taking either path. These include the following.
Patient health-related factors
Patients who smoke, take the modern drugs for osteoporosis management, have uncontrolled or poorly controlled diabetes or who have a suppressed immune system are at a higher risk of developing complications following implant placement. By contrast, these health conditions would rarely affect the outcome of root canal treatment, especially if carried out by a trained endodontist.
Tooth, gum and bone support
In some cases there are no general health impediments to endodontic treatment but there is simply not enough remaining tooth structure on which to build a lasting restoration. Clearly, these teeth are best extracted and an implant-supported crown should be considered.
In many cases, particularly with upper teeth, there is simply not enough bone present to place an implant, and these teeth should be saved by a qualified root canal therapist.
Using implants to replace highly visible teeth, such as upper front teeth, can be challenging as it’s difficult to achieve a good and natural look, particularly with two teeth side by side. On the other hand, a single tooth implant can look great.
As you can see, there are many factors to consider when deciding on the best treatment option for infected and broken teeth. Personally I have had two lower molars split in half in recent years, and both have been replaced with implants. They are great, but I’d still prefer to have my own teeth!