Should tooth #30 be root canal retreated OR extracted and replaced with an implant-supported crown?

 

 

This 22 y.o. female patient presented within one year of root canal treatment and crown placement.  The chief complaint was, “The bottom tooth on the right hurts to hot and cold.”

 

CLINICAL EVALUATION: 

#30 percussion – positive

palpation – WNL

periodontal probing scores – B433, L444 bleeding with probing

mobility – WNL

#30 PFM crown with overhanging margins mesial and distal.

RADIOGRAPHIC INTERPRETATION:

1. PFM with poorly contoured proximal contacts

2. amalgam post(s) build-up

3. previous root canal treatment

4. possible separated instrument(s) in one of the mesial canal(s)

5. increased periodontal ligament space on the mesial root

 

PRE-TREATMENT DIAGNOSIS: 

Previously treated root canal/symptomatic apical periodontitis

 

RECOMMENDED TREATMENT PLAN:

#30 root canal retreatment, possible separated instrument removal

Build-up and new crown

 

DISCUSSION:

The amalgam posts, gutta percha, separated instrument in the mesial buccal canal were removed; calcium hydroxide was placed for several weeks.  The root canal was completed, crown removed, and a new build-up was placed.

ONE YEAR FOLLOW-UP EXAM and RADIOGRAPH:

The tooth is asymptomatic.  The radiograph appears WNL.

 

 

CONCLUSION:

Currently there aren’t any guidelines set forth by the dental profession regarding endodontic versus implant therapy.  There is an ever-increasing amount of literature to assess the outcomes of both endodontic and implant therapy.  A recent major literature review conducted by the Academy of Osseointegration found equal survival rates of single-tooth implants and endodontically restored teeth.  Both therapies had overall survival rates of 94%.

 

However, despite this similarity, the authors concluded that the priority should always be to preserve the natural tooth before extracting and replacing it with an implant.  Most people choose to save their own natural teeth if possible.  Thorough diagnosis, appropriate treatment planning, and the patient’s best interests should guide the practitioner, generalists and specialists alike.

 

Use of a dental microscope, ultrasonic instrumentation, and CBCT imaging when necessary, have led to endodontic treatment that can be managed with greater predictability.