In some cases, a tooth with deep decay or an abscess may be saved by doing a root canal treatment. Root canal treatment is certainly predictable and successful when done in the right circumstances and performed by an endodontist. However, there are times when it is inappropriate and the patient is better served by following up with an oral surgeon to extract the tooth. This treatment process is described in a recent success story of a patient treated in our office. Here are several questions to consider in order to choose the right treatment option:
Is the tooth EASILY and PREDICTABLY restorable? If the tooth decay has extended to the level of bone or underlying root structure, the tooth is highly compromised and often very difficult to restore successfully. In such circumstances, saving the tooth will require a root canal, crown lengthening, placement of a post, build-up, and a crown. The complete treatment is quite expensive and often has a poor long-term prognosis. Recurrent decay, fractures, or loosening of the post or build-up are common complications that ultimately necessitate extraction of the tooth. If a tooth is not easily and predictably restorable, then it should be extracted and replaced with a dental implant.
How is the health of the surrounding bone? If the tooth has suffered significant loss of bone and support due to an infection, then its periodontal health is compromised. In this case, a root canal is inappropriate and the tooth should be extracted. The site should then be grafted to restore the missing bone and prepared for a dental implant.
Are there continued problems in spite of repeated treatments? If a tooth has already been treated with a root canal and there are continued symptoms, bone loss, or swelling, then there may be complicating factors such as fractures, extra canals, calcified canals, or other anatomical complexities that makes a successful re-treatment of the root canal challenging. There may be circumstances in which a re-treatment (second attempt at root canal) may be successful, but, in most cases, it may be best to extract the tooth. Cone beam CT scans are now routinely used to better diagnose such conditions and avoid unnecessary treatments. I recommend seeing an endodontist for definitive recommendations.
What is the expected long-term success of root canal treatment in that tooth? In some circumstances, root canal treatment may be an option, but if it has a questionable prognosis for various reasons, then alternative treatments should be considered. In my opinion, if the long-term prognosis of root canal treatment is less than 90%, then it is best to have the tooth extracted. Dental implants have over a 98% success rate, so they are a much more predictable treatment option. If you are told that root canal treatment might work and are given less than a 90% chance of success, it is probably best to choose extraction and replacement with an implant.
As with any dental treatment, we must always depend on evidence-based dentistry to guide us in choosing the best options. Together with the knowledge base of specialists in the field and better technologies in diagnosis, such evidences help us make better recommendations and help our patients on the correct path.