Redoing a root canal or having tooth extracted?

route9 · 05-07-2016 09:59AM #1

Hi folks,
I was the dentist last week and was advised that I will need to have either a root canal redo / restoration, or an extraction of a bottom tooth – the last one on the bottom (comes just before the wisdom tooth, which was extracted years back).

The problem with the root canal on this tooth is that it was of poor quality, and the canals are now showing signs of infection (or at least one of them is).

The redo of the root canal would involve going through the crown to try and clear up the infection and so on, but there is no guarantee of how long it will last thereafter. However, I am not keen on the idea of losing a tooth through having it extracted, and I have heard about how it can change the shape of your face and other stuff like that?!

Does anyone have any experience of the above? Is getting this tooth (which is at the very back) extracted a better idea than trying to redo the root canal – will it change anything much if I do get it taken out?

I am getting a second opinion on Thursday from a dentist who is really good and who knows my history – the guy I went to last week I had never been to before and so I was rethinking things.

Of course, if I do get it extracted I'll need an implant at some stage, which seems like another big thing to have to get done..

Thanks

Oral Surgeon · 05-07-2016 03:00PM

A redo root canal will have a lower success than the original attempt... I generally advise against it.... but I don't know your specifics....

Maybe at this point, the extraction and implant will offer a more predictable result and better value of your money....

Most importantly, the tooth needs to be removed very carefully to preserve the bone to facilitate a good implant placement....
This is by far more tricky than the implant placement and a badly removed tooth could ruin your chances of having a good implant. Only allow someone competent to do this.... ie whoever is going to place the implant (as he/she will be interested in saving the bone...)

route9 wrote: »

Hi folks,
I was the dentist last week and was advised that I will need to have either a root canal redo / restoration, or an extraction of a bottom tooth – the last one on the bottom (comes just before the wisdom tooth, which was extracted years back).

The problem with the root canal on this tooth is that it was of poor quality, and the canals are now showing signs of infection (or at least one of them is).

The redo of the root canal would involve going through the crown to try and clear up the infection and so on, but there is no guarantee of how long it will last thereafter. However, I am not keen on the idea of losing a tooth through having it extracted, and I have heard about how it can change the shape of your face and other stuff like that?!

Does anyone have any experience of the above? Is getting this tooth (which is at the very back) extracted a better idea than trying to redo the root canal – will it change anything much if I do get it taken out?

I am getting a second opinion on Thursday from a dentist who is really good and who knows my history – the guy I went to last week I had never been to before and so I was rethinking things.

Of course, if I do get it extracted I'll need an implant at some stage, which seems like another big thing to have to get done..

Thanks

route9 · 05-07-2016 04:01PM

Oral Surgeon wrote: »

A redo root canal will have a lower success than the original attempt... I generally advise against it.... but I don't know your specifics....

Maybe at this point, the extraction and implant will offer a more predictable result and better value of your money....

Most importantly, the tooth needs to be removed very carefully to preserve the bone to facilitate a good implant placement....
This is by far more tricky than the implant placement and a badly removed tooth could ruin your chances of having a good implant. Only allow someone competent to do this.... ie whoever is going to place the implant (as he/she will be interested in saving the bone...)

Ok that's very helpful, thanks! Would you say that a regular dentist is fine if I go with the extraction option, or would it better to go with an oral surgeon perhaps? I did go to an oral surgeon for wisdom teeth removal (since they were in very tricky positions). I have an appointment with a dentist I've been to in the past on Thursday, to get a second opinion, and he is very good. This was the same dentist who referred me to the oral surgeon for the wisdom teeth extraction.

Really I don't mind having it taken out as long as it is going to be fairly simple and won't affect my mouth / jaw other than a bit of soreness and so on straight afterwards?

Oral Surgeon · 05-07-2016 06:20PM

From experience, most dentists will "pull" the tooth out and this is usually achieved by expanding, compressing and/or fracture/ crack of the jaw bone.... This will result in accelerated bone resorption...
Some will do a surgical extraction where the gum is lifted back and the bone drilled away to facilitate tooth removal.... This is even worse as the bone is gone gone then!!
Some will do both of these procedures and then sell you an expensive "socket graft" to rebuild the site... Unnecessary.... Nearly always...
Imo the best way to take out these teeth is to leave the gum and bone alone, cut the crown off the tooth and then seperate the roots and remove each carefully while keeping nearly all socket bone...
Some dentists will do this, some oral surgeons won't!! You need to ask if they do this and go from there....

route9 wrote: »

Ok that's very helpful, thanks! Would you say that a regular dentist is fine if I go with the extraction option, or would it better to go with an oral surgeon perhaps? I did go to an oral surgeon for wisdom teeth removal (since they were in very tricky positions). I have an appointment with a dentist I've been to in the past on Thursday, to get a second opinion, and he is very good. This was the same dentist who referred me to the oral surgeon for the wisdom teeth extraction.

Really I don't mind having it taken out as long as it is going to be fairly simple and won't affect my mouth / jaw other than a bit of soreness and so on straight afterwards?

btkm8unsl0w5r4 · 05-07-2016 07:30PM

OP if the tooth can be predictably saved then save it. You may very well be able to retreatment to root canal system and get many years service more from the tooth. It might also be the case that retreatment does not work, having said that the implant might not work either. Best seek that second opinion.

Once the tooth is gone, its gone. I would exhaust the possibilities before dooming it to the bin.

caille · 05-07-2016 07:43PM

Definitely get a second opinion, even get a third opinion if you are still not happy. If you do get the tooth extracted and think you can live without it, think again. I decided I wanted to be able to continue eating steak and apples and you need your back teeth for both. I am no dentist but have had a lot of problems with my back teeth and have had to get a few opinions. The advice of getting the tooth extracted by the same dentist who can do an implant is spot on, that is the route I had to go with one of my back teeth and the other one I was able to save with a second root canal.

I have a great dentist now but only because I finally learned to ask the right questions after many years of not asking them and paying the price (both literally and figuratively).

route9 · 05-07-2016 08:44PM

caille wrote: »

Definitely get a second opinion, even get a third opinion if you are still not happy. If you do get the tooth extracted and think you can live without it, think again. I decided I wanted to be able to continue eating steak and apples and you need your back teeth for both. I am no dentist but have had a lot of problems with my back teeth and have had to get a few opinions. The advice of getting the tooth extracted by the same dentist who can do an implant is spot on, that is the route I had to go with one of my back teeth and the other one I was able to save with a second root canal.

Wow, I see. Even just with one back tooth missing? Certainly I love my steak! This tooth is at the very back and as the first dentist said, I have other back teeth. I suppose you won't know if you'll miss it until it's gone though? Did you get more than one back tooth removed?

Yep, that advice on the implant is great. Makes total sense but not something I'd have thought of at all...

caille wrote: »

I have a great dentist now but only because I finally learned to ask the right questions after many years of not asking them and paying the price (both literally and figuratively).

If your dentist is in Dublin and you wanted to PM me his or her name that might be good...in case I need a third opinion!

route9 · 05-07-2016 08:46PM

Tyler Loose Barefaced wrote: »

OP if the tooth can be predictably saved then save it. You may very well be able to retreatment to root canal system and get many years service more from the tooth. It might also be the case that retreatment does not work, having said that the implant might not work either. Best seek that second opinion.

Once the tooth is gone, its gone. I would exhaust the possibilities before dooming it to the bin.

Thanks, I'd definitely like to keep it. The dentist I am going to on Thursday for the second opinion is great, he knows my history and he has won awards (or one at least) and sits on the boards of various associations, etc. He is very professional and so I'm looking forward to hearing what he has to say.

As I said, I don't mind an extraction too much, but I am a bit concerned that it might affect other things...I asked the first dentist whether removing it would affect my bite, but he said not at all.

route9 · 05-07-2016 08:48PM

Oral Surgeon wrote: »

From experience, most dentists will "pull" the tooth out and this is usually achieved by expanding, compressing and/or fracture/ crack of the jaw bone.... This will result in accelerated bone resorption...
Some will do a surgical extraction where the gum is lifted back and the bone drilled away to facilitate tooth removal.... This is even worse as the bone is gone gone then!!
Some will do both of these procedures and then sell you an expensive "socket graft" to rebuild the site... Unnecessary.... Nearly always...
Imo the best way to take out these teeth is to leave the gum and bone alone, cut the crown off the tooth and then seperate the roots and remove each carefully while keeping nearly all socket bone...
Some dentists will do this, some oral surgeons won't!! You need to ask if they do this and go from there....

Wow...way above the layman's head all that I think! Will definitely ask about these things. You would just think you can trust your dentist to choose the right option but it seems that's not the case at all....

Would most dentists go with the third option which sounds best? Really I had a lot of trouble with my teeth years back (impacted wisdom teeth causing decay which lead to the root canals), and don't want to have to be doing too much with them after having all that going on years ago..

route9 · 06-07-2016 08:08PM

Okaaaayy....

So I had a sweet earlier and after two bites I felt something....off comes the crown on the tooth in question!! Mad. I don't know if the slight infection at the base could affect the crown like that, maybe...

Oral Surgeon · 06-07-2016 09:54PM

route9 wrote: »

Wow...way above the layman's head all that I think! Will definitely ask about these things. You would just think you can trust your dentist to choose the right option but it seems that's not the case at all....

Would most dentists go with the third option which sounds best? Really I had a lot of trouble with my teeth years back (impacted wisdom teeth causing decay which lead to the root canals), and don't want to have to be doing too much with them after having all that going on years ago..

Some dentists don't know how to do option 3 or don't see the value in it....

Oral Surgeon · 06-07-2016 09:55PM

route9 wrote: »

Okaaaayy....

So I had a sweet earlier and after two bites I felt something....off comes the crown on the tooth in question!! Mad. I don't know if the slight infection at the base could affect the crown like that, maybe...

Not a good omen for the tooth.

simdan · 06-07-2016 10:02PM

Get rid of it and get an implant. Not a whole lot more than a root canal and a crown. I've been quoted 2800e for two extractions, two implants and a bridge. I think that's not bad after spending well over a grand on a tooth I lost a few years ago following 2 root canal treatments.

Esel · 07-07-2016 12:07AM

simdan wrote: »

Get rid of it and get an implant. Not a whole lot more than a root canal and a crown. I've been quoted 2800e for two extractions, two implants and a bridge. I think that's not bad after spending well over a grand on a tooth I lost a few years ago following 2 root canal treatments.

Seems very inexpensive to me - but then I'm only a punter.

btkm8unsl0w5r4 · 07-07-2016 07:41AM

Esel wrote: »

Seems very inexpensive to me - but then I'm only a punter.

actually that is worryingly and astonishingly cheap if the posters description of the treatment is accurate. 3 unit implant bridge??

Redoing a root canal or having tooth extracted?

Comments