Patients and dentists often face a complex dilemma – whether to save a tooth using root canal treatment and a permanent restoration (a filling or a crown), or remove that tooth and replace it with a dental implant and a crown. While some dentists have a strong preference for one treatment or the other, most dentists treat every patient and every tooth as a unique case. Dentists weigh the condition of the tooth, the patient’s general dental and medical health, financial considerations, and the patient’s preference.
Deep tooth decay and trauma (accident) may damage the pulp of the tooth. The pulp is the soft inner part of the tooth; it is the part of the tooth that includes the nerve and blood vessels. The root canal is the hollow part of the tooth that contains the pulp. Root canal treatment means that the dentist removes the pulp from the tooth through a hole in the top of the tooth. The dentist fills the hollow tooth down to the tip of the root with a long lasting, rubbery material. In some cases, a hard filling to plug the hole in the biting part of the tooth is all that is necessary to restore the tooth to normal function. A tooth that is under more stress like a molar, or a tooth that has more damage requires a cap or crown to rebuild it.
The success of root canal treatment is very likely, but not certain. Sometimes root canal treatment is not able to remove all of the pulp or infection. If the pulp dies because of a crack in the tooth, root canal treatment will not fix the problem. Since cracks are hard to see and diagnose, sometimes dentists treat cracked teeth without realizing. Sometimes, the shape of the root canals is so complicated that it is not possible to completely clean the canals.
Sometimes, teeth are so broken down by decay or accident that it is not possible to restore those teeth even with a crown. Dentists may be able to salvage some teeth with periodontal (gum) surgery to expose more of a broken tooth. That surgery may expose more of the root of the adjacent teeth which will make those teeth sensitive and more susceptible to gum disease and decay.
Dentists may attempt to repair a tooth with a questionable prognosis. Later, the patient and dentist may find that restoration is difficult or impossible, or that the does not last. Even a relatively strong tooth that receives root canal treatment and a crown may develop gum disease, decay, or fracture. It is easy to understand the importance of thorough diagnosis and planning.
Dental implants are artificial tooth roots, made of titanium, that anchor crowns (caps) or dentures to the dental bone. The bone actually knits to titanium. While implants are not 100% effective, they are even more reliable than root canal treatment. Dental implant retained crowns are a reliable, aesthetic, and long lasting restoration. Gum disease, trauma, and malocclusion (bad bite) may cause an implant to fail prematurely. Implant retained crowns are not susceptible to tooth decay.
Replacing a tooth with an implant takes time and planning. The restoring dentist who places the crown on the implant and the surgeon who places the implant in the bone (sometimes this is the same dentist) will take or retake a thorough health history. Dental implants are not a good option for patients who take some medications such as bisphophonates like Actonel, Aredia, and Zometa. Also, uncontrolled diabetics and some controlled diabetics who do not heal well, are not good candidates for implant surgery. There are many other medications and medical conditions that preclude implant surgery. It is the responsibility of both the surgeon and the restoring dentist to take a complete medical history and council their patients accordingly.
The dentist should create models of the patient’s teeth. Then, the dentist or lab technician will change the model to demonstrate the appearance of the new crown. The surgeon relies on a stent or a physical guide to know exactly where to place the implant. The restoring dentist or the lab technician creates the stent and sends it to the surgeon. The surgeon should place the implant where the restoring dentist needs it. Never allow a surgeon to place a dental implant without consultation with the restoring dentist.
There are other considerations when treating a tooth with root canal treatment or replacing that tooth with an implant retained crown. Time may be a concern. A dentist may be able to complete root canal treatment and restoration in as little as a day. Removal and replacement of a tooth with an implant retained crown might only take a few months, but it may take the better part of a year for preparatory surgery, healing and restoration.
Another consideration is the state of mind of the patient. Does the patient understand the procedures? How does the patient feel about root canal treatment? How does the patient feel about dental surgery? How does the patient feel about loosing a natural tooth?
Finances are a common concern of dental patients. Both root canal treatment and dental implants are expensive procedures. These procedures are time intensive and require the use of expensive equipment and materials. Many patients have dental insurance coverage, but insurance companies cover these procedures at different rates, and some dental insurance plans do not cover crowns or implants at all. Ask the dentist or their representative to provide a written estimate of the costs of treatment including insurance coverage if applicable. These treatments may take a long time to complete. Be certain to inform your dentist and their staff immediately if your coverage changes.
If you face treating or replacing a tooth, speak with your dentist. You may want to obtain a second opinion. You may have other options than the two in this article. Only you and your dentist or dentists can determine the best treatment for you.