Teeth with advanced caries that have been treated with root canal often require a post, build-up and a crown to restore them. While root canal treatments performed by endodontists have good long term prognosis, the teeth themselves are often subject to irreversible damage from recurrent caries or cracks which typically can not be treated and therefore require extraction.
Extraction of teeth with existing root canal is a complex procedure. The tooth and its roots become very brittle and fracture easily during extraction. This requires careful surgical techniques to remove the teeth gently while preserving the surround bone important for healing and future implant placement. Here are the key considerations for a successful outcome if you need extraction of a previously treated tooth with root canal:
- Request an oral surgeon for the extraction as they are most experienced in this procedure. Special techniques and instruments are necessary for proper extraction.
- Discuss possible bone grafting immediately following extraction as bone is often missing or thin following extraction. Bone may be deficient either due to chronic infection or lost during surgical removal of the tooth. Bone grafting will allow a healthy site f0r future implant placement.
- Thorough removal of the abscess or inflammatory tissues to allow a rapid healing. Teeth with root canal often have periapical abscess or other types of inflammatory tissues that must be carefully removed. This is important for proper healing and regeneration of bone.
- Complete tooth removal- Because teeth are brittle and fracture very easily during extraction, it is easy to miss tooth fragments and leave them behind. This can result in either infection or problems placing a dental implant at a later time. An experienced surgeon has the skills and the necessary instruments to remove teeth completely and make sure there no fragments left behind.
- IV sedation anesthesia- Because of its complexity, the extraction of such teeth are best done under IV sedation for optimal comfort. The extraction often requires drilling and sectioning of the roots and controlled pressure of special elevators. Even if you are numb with local anesthesia, the sensation from such interventions may be uncomfortable.
- Immediate implant placement may be considered if the extracted tooth is an incisor, canine, or a premolar. However, it should only be done if the infection is completely removed, the quality of the surrounding tissue is good, and the bone is abundant and healthy. Otherwise, the site should be allowed to heal and then place the implant in 2-3 months.