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Troy Reconstructive Cosmetic and Implant Dentistry
Sensible Use of Root Canal Therapy (RCT) Treatments
Recommendations for root canal therapies can arise from situations where tissue conditions indicate the existence of inflammation, infection or unusual pain perception issues that have become significant.
In many other instances, the recommendations for a root canal therapy treatment can seemingly arise or be caused by recent treatments for the affected tooth.
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| Two Failed RCT's |
Depending upon the location and biting characteristics of a given tooth (anterior versus molar), tissue conditions (bone, root and periodontal) and undiagnosed changes in occlusal plane dynamics .... seemingly routine dental treatments can "cause" the need for a root canal treatment.
Knowing when certain conservative treatments can increase the probability of a future root canal treatment should be fully discussed. Suspected treatment failures, if monitored or managed effectively, can eliminate the need for additional treatment costs.
Root Canal procedures can fail for several reasons.
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| Damaged Teeth Extractions |
For molar tooth locations, the high probability of having branched or convoluted roots, which often can't be seen or detected via xrays, increases the chance for eventual failure.
In the pictured treatment series presented here, one tooth broke at the gum line while the other, adjacent root canaled tooth showed signs of failure and was impacting the surrounding soft tissues.
The second photo in this treatment series demonstrates how root canaled tooth structures can further deteriorate, due to the nutrient disruption that accompanies a root canal treatment. Notice that two root canal files were broken and left untreated in the same root (of the broken tooth).
Broken Files: Who is to Blame?
Files rarely break due to dentist error.... rather, it is a reflection of the physical characteristics of the tooth root(s). In this case, many dentists or specialists would have curtailed treatment and recommend an extraction with dental implant replacement.
Unfortunately, despite the advances in digital radiography (2D and 3D xrays), many tooth structures cannot be diagnosed at the 100% level. Branched and convoluted roots don't "show" well.
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| Xray Evidence of Potential RCT Failure |
As a result, some patients may have a root canal treatment that is not 100% successful in eliminating the perception of pain, discomfort and in some cases, repeated infections.
This event is usually attributable to "unseen tissue conditions".
Endodontists, who specialize in Root Canal Therapy, despite having high power magnification and microscopy, also experience these types of treatment failures.
Missed Red Flag(s): Beginning of the End?
The 2D xray provided here provides overwhelming evidence that one tooth has shifted and slanted.
Because successful root canals cause an immediate obstruction or obliteration of the normal nutrient supply to the remaining tooth structure (which is why immediate crown restorations are always recommended), the slanted tooth structure was doomed to fail. Not "if".... only "when"....
The broken files should have provided additional "signals" that the RCT would be at risk for failure. The ensuing inflammation and infection eventually affected the adjacent tooth that was also treated.
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| Reconstructive Bone Grafts |
Sensible Retreatment
The only sensible retreatment for the two failed root canals that probably should have been recommended from the very beginning is extraction and dental implant replacements.
Dental implants thrive in high bite pressure environments (molar areas) when supported by substantial, healthy bone.
The extraction sites for this patient were treated with bone graft material to specifically correct lost height and width. The sites were allowed to completely heal (average is 3-4 months). See photo of newly healed bony ridge.
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| Placement of Implants |
Once healed, the newly fortified ridge of bone was prepared, via implant surgery, for two (2) select precision implants that were correspondingly sized for the patient's bone characteristics.
Temporary Implant Crowns
Acrylic temporary crowns were used to assure ample time for making final adjustments for fit, feel and adapting to the patient's occlusal plane.
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Completion of Implant Restorations
New Porcelain Teeth |
Since the new tooth structures couldn't be seen in the patient's customary smile, color shading was not critical.
After a few weeks, when all technical considerations (from Dr. Nazarian's perspective) are satisfied and the patient confirms the return of normal dental function, the temporary crowns are used as models or templates for the new porcelain restorations.
RCT Recommendation Summary
Root canal treatments that fail, for any one of several causes, can be a considerable cost to absorb especially if recent, previous treatments have seemingly contributed to the overall failure.
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| Xray Confirmation: Healthy Root Form Implant Replacements |
Although retreatments of root canaled teeth can be very successful and result in good conservation of treatment dollars..... there are some situations where retreatment may be short lived and require even more retreatments but in the form of tooth replacement.
The location or position of the tooth, current health of the tooth, bite characteristics, food preferences and treatment history of the affected tooth or even adjacent tooth structures as factors, ultimately influence the patient's decision to elect one treatment over another.
Treatment cost can easily become secondary when multiple retreatments of failed procedures to "save" a tooth begin to accumulate.
Questions?
Patients who suspect they may need root canal treatments or are faced with a retreatment need are invited to contact our office or Dr. Nazarian directly to determine which treatment or retreatment makes the most sense in minimizing invasiveness and long term treatment costs.
Call our office at (248) 457-0500 to schedule a consult with Dr. Nazarian or use our on=line Consult Request form. Answers or questions related to any content appearing on this page can also be discussed with Dr. Nararian via our Ask The Dentist form. Dr. Nazarian will reply to you directly.
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Michigan Reconstructive Implant Dentistry
Ara Nazarian, D.D.S.
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501
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