Are implants are the new replacements for root canals?


I remember when it was standard operating procedure to try and save every tooth possible. If a tooth had a nerve was exposed or a tooth had an endodontic periapical lesion then a root canal, post and crown was the treatment of choice even,  if crown lengthening might be needed. Not so much now a days. Many teeth that we would save in the past are now deemed questionable and too risky to save. Often extraction and implant restorations are the treatment plan chosen. I, given the money involved most dentists and our patients  opt for the most predictable treatment plan that will result in a long lasting result.

Implants,  in the proper situation, are very predictable and end up costing about the same as restoring a tooth that requires  root canal, post and core, crown lengthening and then a crown. Further more teeth with root canals seem to be more prone to fracture than regular teeth and implants as well. That being said, there are still plenty of reasons to "save this old tooth''.

If the tooth has enough bone support and enough remaining ferrule ( viable exposed tooth structure to hold a crown), than root canals and a crown restoration afterwards isthe still the preferred treatment plan. Root canals have over a 95% success rate. When  properly restored with a crown,  teeth often can remain in the mouth for 10+ years. Some of my patients have teeth that had root canal performed 40 years ago and are still functioning well.

Since even implants may not last indefinitely, having a root canal and a post and a crown that may last 15 to 20 years is a good way of "kicking the can down the road". Most likely if the  tooth does fail and need to be extracted, by that time our profession will have improved our implant techniques and the implant should end up being even a better replacement (than one done using today's protocols).

Now many endodontists take care to conserve tooth structure when performing their root canals since the profession is in general agreement that conservative root canal preparation that conserves tooth structure makes subsequent root fractures less likely. That coupled with tooth conservative crown preparations make long lasting results even more likely.






from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/05/implants-are-new-replacements-for-root.html - http://lspindelnycdds.blogspot.com/

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