should I get a root canal or implant?

Dr. Raymond E. LaVigne practices dentistry in Palatine, Illinois. His specialties are cosmetic dentistry, dental implants, and patient education. This article will highlight root canal treatments, causes of needing a root canal, and possible benefits, risks, and complications of having a root canal procedure.

 

Root canal treatment involves the removal of the pulp (soft tissue from the channel within the root of a tooth). The pulp is comprised of blood vessels, connective tissue and nerve. The pulp is needed when a tooth is in active growth stages. The blood vessels provide calcium as the tooth matures from the inside. The walls of the root (as well as the visible coronal part of the tooth) grow thicker as the calcium is transformed into dentin.

Roots typically reach maturity in length and thickness of the walls within about 2 – 3 years after the tooth erupts into the mouth.

After that time, additional calcification may continue. Additional calcification comes as a response to such stimuli as:

• Hot or cold temperatures – the tooth attempts to further “insulate” itself

• Decay – the tooth attempts to repair itself as decay advances from the outside

• Unusual biting or clenching forces – the tooth calcifies inside the pulp canal as a response to the on and off pressures felt at the apex of the root where the blood vessels enter and exit the end of the root.

Common reasons for needing a root canal include:

1) Decay has accelerated beyond the ability of the repair process so that bacteria enter the pulp from the outside. In some cases there is direct entry of bacteria. In other cases, the acidic excretions of bacteria cause the irritation and pain, but there is no actual infection.

2) Tooth fractures allow bacteria or their acidic excretions to come in contact with the pulp.

3) Tooth trauma. Sudden force can cause the tooth to be intruded into the bony socket. This can sever the blood vessels so that the tooth no longer has live blood flow within. This causes the remaining soft tissue of the pulp to break down ("dead nerve"). Having a dead nerve or necrotic pulp can temporarily mean no pain but later can lead to infection from the toxic debris.

4) Teeth clenching. Constant, repetitive forces can cause the same cutting off of the blood flow. Clenching can slowly cause the pulp to calcify along the canal walls. As the channel becomes smaller in diameter, blood flow gradually decreases. Another response to abnormal forces is a pulp stone. Instead of or in addition to narrowing of the canal walls, a pulp stone accumulates in the pulp chamber. At some point it can also cut off the flow of blood.

5) Restoration needs.  Sometimes a root canal is recommended or necessary in order to provide proper strength or adherence of a filling or crown. Sometimes there is no direct exposure of the pulp however, the preparation for the filling or crown will either expose the pulp or come so close that the tooth will be extremely sensitive and have a high

Some teeth having previously large fillings or crowns or having major fractures will need a post in order to retain a new crown. A post can only be placed if a root canal is performed first.

 

Factors that make root canals highly successful:

• Vital: fresh pulp – little or no bacterial contamination
 
• Normal to fairly large canals
 
• Straight to slightly curved root forms
 
• Technique, details followed during treatment
 
• Good to excellent placement of temporary filling

• Good and timely placement of permanent restoration following root canal

Factors that complicate root canal treatment:

• Some bacterial contamination of the pulp
 
• Significantly small diameter canals 
 
• Highly curved or irregular root forms
 
• Intersecting or lateral accessory canals – tiny side branches from the main canal
 
• Significant wall calcification or pulp stone making entry and negotiation difficult
 
• Delay is seeking initial treatment or completing permanent restoration
 
• Challenging situations such as location of tooth, ability to open wide, ability to effectively isolate the tooth with a rubber dam, alignment issues that make taking accurate x-ray difficult

• Re-treatment of root canals with no structural challenges but with return of bacteria from a recurrent cavity allowing bacteria to reach the previously sealed canal

Factors that make root canal treatment highly risky:

• Gross bacterial contamination, long-term and beyond the canal into surrounding bone, possibly sinus involvement
 
• Extremely curved and also very small diameter combinations
 
• Complete calcification so that a canal cannot be entered even with the finest file size
 
• Extremely large pulps such that walls are thin and vulnerable to fracture
 
• Failure by patients to follow through with permanent restoration
 
• Re-treatment of root canals with major complications such as blocked passages and other obstacles

• Teeth that have been grossly exposed to bacteria for an extended time so that the tooth structure is highly compromised – Softened or thin and brittle will not allow long term success with restorations – fillings will not hold, cemented crowns will not adhere long term or there is a high chance of fracture simply from normal chewing.

Implants may be a better option rather than perform extensive procedures (i.e. getting a root canal) with great risk.

With all the advancements, implant placement and restoration has become much more reliable and predictable.

Thank you for reading,
Dr. Ray

 

 

Dr. Raymond E. LaVigne DDS is a practicing dentist in the Chicagoland area for over 30 years.
Please call our Palatine, IL dental office for an appointment: 847-359-1292.