Can dental implants be an alternative to root canal treatment?

Root canal treatment and tooth extraction are the two most common procedures to treat damaged or infected teeth which may be causing you serious pain.  A root canal repairs your tooth, saving it from having to be removed.  A tooth extraction is usually the alternative treatment option and a dental implant may be recommended to fill the gap.

Root canal therapy and dental implants are not in competition.  If one type of restoration isn’t suitable, then the other might be the answer, or the next stage in the clinical process.  Where possible, dentists will always look to preserve the natural tooth.  The question of whether to save and when to replace a tooth, ultimately comes down to individual circumstances and what treatment option is best for you.  When implemented successfully, both can help to restore comfort, the ability to chew and your natural smile. 

Contents:

• How do I know if I need root canal treatment?
• Can pulpitis be treated?
• Save or replace a tooth with a dental implant?
• What happens during a root canal procedure?
• What are root canal complications?
• Can a root canal be retreated?
• What is the cost of root canal treatment?
• When should a tooth be extracted and replaced with a dental implant?
• Root canal treatment or dental implant - will anyone notice?
• How do I decide which treatment is best for me?

How do I know if I need root canal treatment?

The procedure is referred to as a ‘root canal’ because it involves cleaning out the infected pulp and bacteria from the internal canals of your tooth that extend into the root.  The National Health Service (NHS) states that “root canal treatment is needed when dental X-rays show that the pulp has been damaged by a bacterial infection.” 

The pulp is the innermost part of the tooth and is protected by enamel and dentine.  Pulp consists of tiny blood vessels and nerve tissue.  The tooth’s outer layers can be damaged or compromised by problems such as decay, cracks, a faulty crown or trauma.  If the pulp is exposed, bacteria can enter and inflame the living pulp tissue (pulpitis).  This can lead to pressure building up in the pulp cavity affecting the nerve of the tooth, which causes pain. 

Can pulpitis be treated?

There are two types of pulpitis.  If the inflammation is mild, the tooth pulp can usually be saved.  This is called reversible pulpitis.  In most cases, the condition results from decay, which the dentist can remove.  After a filling is placed, the inflamed pulp may recover and heal.  When the pulp of a tooth has been badly affected and the damage and pain is severe, the pulp can start to die.  This condition is irreversible pulpitis and the infection must be removed to stop the pain and prevent it from spreading.  Left untreated, infection may extend through the root canal system of the tooth and can lead to an abscess and other problems. 

Save or replace a tooth with a dental implant?

If a tooth has irreversible pulpits, saving it is always the preferred option.  The most common corrective measure that a dental professional can use to achieve this is root canal (endodontic) treatment.  The procedure removes the infected, diseased pulp. 

When a tooth has the potential to be saved, a root canal should be proposed.  But there are occasions when this is not possible.  Insufficient tooth tissue or deep decay can make restoration difficult.  Problems can also occur when teeth have endured several treatment attempts.  If the natural tooth cannot be restored, it might be time to consider extraction and a dental implant to fill the gap.  An implant is fixed into the jawbone to replace the missing root and support replacement teeth.  

In summary, a root canal procedure is intended to repair and save an infected or decayed tooth, while a dental implant replaces and restores by filling the gap left by an extraction.

The following information will help you understand what root canal treatment entails and when a tooth extraction and dental implant replacement might be necessary:

What happens during a root canal procedure?

A general dentist or endodontist (root canal specialist) makes a small access hole in the tooth’s surface.  The pulp and bacteria are removed from inside of the tooth and its canals.  The pulp contains blood vessels, nerves and connective tissue.  Dentists use a series of root canal files of different sizes which are worked down the full length of the tooth, to clean out and enlarge the root canals.  The canals are usually very narrow.  Dentists use the files to make the canals larger, so they can eventually be filled.  The number of canals will vary depending on the type of tooth receiving treatment.  Your front incisors and canine teeth usually have one root containing one canal.  The back molars can have two or three roots, each with either one or two root canals.

According to the NHS, “If the treatment needs to be carried out over several sessions, your dentist may put a small amount of medicine in the cleaned canal in between visits to kill any remaining bacteria.  The tooth will then be sealed using a temporary filling.”

At the next appointment, the empty space inside the root of the tooth is filled (obturated) with a sealer paste and a rubber compound called ‘gutta percha.’  A filling is placed to close the exterior access hole.  Finally, because a ‘dead’ tooth is more brittle, you may need to have a crown over the top to provide extra support and strength.

What are root canal complications?

After endodontic treatment, a fully developed tooth can survive without the pulp as the absence of a nerve will not affect its function.  Although it is an effective treatment to save a natural tooth, not all root-canal-treated teeth will become totally symptom free or last a lifetime.

Initial root canal therapy may fail due to:

• Further decay
• Root canal reinfection because of a defective dental restoration that has allowed bacteria back inside the tooth
• One of the root canals in a tooth being missed
• A canal not being fully disinfected
• Fracture of a restoration or tooth root
• Breakdown of the inner sealing material
• Bacteria not being fully removed from the infected root canals, despite a dentist’s best efforts

Can a root canal be retreated?

If the infection has returned and the same tooth is giving you problems, it can sometimes be retreated.  The dentist may decide to ‘disassemble’ the original work which may include removing or drilling through the existing crown to access and retreat the root canals. 

Most dentists can carry out endodontic treatment but you may be referred to a specialist endodontist for retreatment.  The procedure can be more challenging and may require additional equipment.

If an infection develops and continues after a root canal, an apicoectomy, or root end surgery, might be recommended.  An incision is made in the gum near the root of the tooth to reveal and remove any inflamed or infected tissue.  The endodontist will also remove the tip of the tooth root, and the end of the root canal is sealed with a small filling.  Stitches close the incision and bone in the jaw heals around the end of the root over the following months.

What is the cost of root canal treatment?

The British Endodontic Society states, “The expense of an endodontic procedure varies depending on how severe the problem is and the type of tooth.  Molars with two or three canals are more difficult to treat and the fee will therefore be more.”

If retreatment is needed, the endodontist will explain the procedure and costs to you.  The original root filling will need to be removed and the canals cleaned out again.  In many cases the restoration protecting the tooth, such as a crown, will have to be taken off and replaced with a new one after the work is complete.  The British Endodontic Society adds, “The cost of the retreatment is usually dependant on how complex the procedure might be but would normally cost more than the original root canal treatment.”

When should a tooth be extracted and replaced with a dental implant?

In most cases, the alternative to root canal retreatment or an apicoectomy is extraction.  Your dentist will assess the tooth and may recommend that it is removed and replaced.  Some patients may simply want to avoid undergoing further root canal procedures.  Many people report that placement of a single dental implant can be a lot less traumatic.

To fill the gap after extraction, a dental implant can be inserted into the jawbone to replace a missing tooth root.  An implant is usually made of titanium, with a thread pattern and a tapered shape.  The implant supports a cosmetic crown that looks and feels like a real tooth.

The timeframe for fitting the implant and replacement tooth or teeth can depend on many different factors.  On the day of treatment, placing a single implant in the jaw may take about half an hour.  Several implants will naturally take longer.  In a straightforward case, many dentists will want to leave the gum to heal and the implant to fuse (osseointegrate) with the jawbone, before fitting permanent, replacement teeth.  There is usually a period of healing lasting from six weeks to six months.  Depending on whether the patient has undergone bone augmentation, the final replacement teeth are generally fitted between three and nine months following surgery.

Root canal treatment or dental implant – will anyone notice?

You retain your natural tooth after a root canal procedure and no-one will be able to tell that it has been root filled.  But sometimes it can darken over time, particularly if the tooth has been damaged by an injury.  This can be rectified by your dentist with veneers, composite treatment, crowns or internal bleaching.

If your tooth is extracted, you can choose to have a dental implant placed.  An implant will look and feel like your natural teeth.  The titanium post fuses with your jawbone and gum tissue grows up around the replacement tooth.  The dental crown is made from ceramic which mimics the shape, lustre and translucency of tooth enamel.

How do I decide which treatment is best for me?

If you have a tooth with irreversible pulpitis, any clinical decisions should always be made with your long-term oral health and individual needs in mind.  Certain factors including restorability, the quality of bone in your jaw and your budget will all be taken into consideration. Your dentist will listen to your concerns, explain your treatment options and help you to make an informed decision. 

This article was written with advice from:

Dr Senthil Thiagarajan