Dentists, is implant better than a third root canal?

[SconeRhymesWithPhone]

I've been having pain on the right side of my face for the last few weeks. Thought I had food stuck between teeth because the gum was inflamed. Dentist gave antibiotics.

Went back today, because even with the stronger antibiotics (metronidazole and amoxicillin) the pain was getting worse. Pain seems to me to be coming from a tooth which was root filled in 1999 and again in 2000 following infection and abscess.

Dentist drilled out filling and as much of root fillings as he could to try to find the source of the pain. He couldn't get all the root fillings out, so has left me with the choice of paying for a specialist to redo the root filling or going down the extraction and implant route.

Since this tooth has already had two root fillings, I'm inclined to go for extraction and implant. The dentist, however, seems to think I should preserve the tooth at all costs. He's not clear why though. The root filling from the specialist will cost around £1000, which is money wasted if it doesn't work.

The implant will be around £2000, but this seems a better bet as it's more likely to work I think. Does that sound right, or am I missing something? I don't see why he's so keen for me to try to preserve the tooth at all costs, especially as either course of treatment is private so he won't gain financially either way. Can any dentists give a view? Tia

Dear Tia,

I was sorry to hear about your dental problems and I hope that you’re feeling better.

It is difficult to give you definitive advice as I don’t have the full details of your problem, but I hope these thoughts may help you.

Generally in order for a root treated tooth to be successful, a number of key objectives need to be achieved.

Firstly the tooth itself should be in a good condition prior to the root canal treatment and be able to support a good quality restoration or filling that seals the tooth during and after the root canal treatment.

The root treatment should be carried out in a clean and sterile environment and the use of a rubber dam during the treatment should be used in order to achieve this.

Secondly the root canals themselves need to be located and cleaned as close to the end of the root canals as possible and then filled completely prior to the tooth being sealed with a good quality restoration or filling.

Often a crown or cap may be used for teeth following the treatment.
If this is carried out the treatment has a high success rate and the patient has the benefit of keeping their natural tooth.

You can see some more information on the process by following this link:
www.britishendodonticsociety.org.uk/patients/index.php

When a treatment fails it may be due to a number of these key objectives not being achieved or indeed the problem could be coming from another source nearby such as another tooth.

In addition to this teeth which are heavily infected prior to the original root canal treatment may not respond to treatment and develop problems that require further treatment such as surgery to assist the healing process. Common additional reasons for failure are leaking fillings on the tooth in question or gum related problems around the tooth.

Teeth can be root treated again if it is possible to get a better result than had previously been achieved.

In your case one way of approaching your problem might be to have a consultation appointment with a Specialist Endodontist who might be able to assess your tooth, make a definitive diagnosis for your problem, and advise you if the tooth could be improved prior to embarking on the treatment.

I hope this helps you in making a decision and I hope that your problem will be resolved soon.

The British Endodontic Society is currently running a survey to collect information about patients’ experiences of root canal treatment. As a patient of root canal, if you have a spare 5 minutes, we would be very grateful if you could fill out our survey which can be accessed here: www.surveymonkey.com/s/rootcanalpatients

Regards,

Murray Saunders
President of the British Endodontic Society

No expert opinions from me, just a regular poster with rubbish teeth.
Last year as I was being assessed for implants following the failure of one bridge the tooth supporting another bridge started to niggle. There was no way I could afford implants to replace both bridges. I was given the choice of trying root canal treatment on the dodgy tooth and was advised to go to an independent expert, not my own dentist, at a cost of £500. As I was already paying over £2k for the implants I settled for an NHS job with my own dentist - he knew it was very important to get it right! A year later my root canal filling seems to have done the job, and I have a lovely smile with my 2 implants in place. The implants were very inexpensive because the specialist does nothing but implants day in day out and they have an excellent reputation. I can provide details if you PM me.