November 11, 2008— SARASOTA, FLORIDA — For years, root canals have been viewed as a way to salvage a tooth and allow a patient to keep it longer.

Now there is another option- dental implants.

Sarasota Cosmetic Dentist Dr. Charles Crane likens root canal therapy to that of saving a dead tree.

“The tree can remain in the ground and stay there, but it is not alive,” Crane said. “It is brittle and dry. You could still hang lights on it, but I certainly wouldn’t hang a tree swing or anything that would cause it extreme duress.”

Teeth are the same way, he said. When a nerve gets infected, the pulp, blood vessels and nerves are taken out and the canal is filled. Root canals are very complex, with many small branches off the main canal.

Like the dead tree, that tooth ceases to be as strong as it once was. However, the tooth can remain and function. This usually is accomplished with a full coverage restoration around it to give it further strength in the event that it was badly compromised. This fix sometimes can last an additional 15 to 20 years if properly cared for.

Root canals often have to be performed on the molars because they are the “working teeth” with the deep grooves that as younger children, often were difficult to keep clean, Crane said. These teeth were subject to decay, followed by fillings. If silver fillings were involved, they sometimes leaked and broke down over time. For that reason, it’s not uncommon that eventually some of these teeth would be in need of root canal therapy.

It’s important to note that root canals are not a 100 percent guarantee that a patient’s tooth can be salvaged. Sometimes the root canal therapy doesn’t take, he said. If the root canal fails, there are options to re-treat. The success rate for re-treatment of root canal teeth is less than 50 percent.

An apicoectomy may be needed when an infection develops or persists after root canal treatment or re-treatment. Because root canals have many small branches off the main canal, sometimes infected debris can remain in these branches and possibly prevent healing or cause re-infection later, according to www.colgate.com. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root. This procedure sometimes is referred to as endodontic microsurgery because the procedure is done under an operating microscope.

Implants As An Alternative

Implants were considered “cutting edge technology” as early as 10 years ago, so re-treatments remained “very good options instead of losing a tooth and then involving bridges and other prosthodontic measures,” Crane said. However, dental implantshave earned a good reputation as a viable alternative to re-treatment, due to their successful track record.

In fact, root canal re-treatment often is referred to as “pre-implant” therapy, Crane said.

Patients who are facing possible re-treatment should consult with a restorative dentist to have the broken, old or failing root canal teeth evaluated.

“The restorative dentist who understands full mouth rehabilitation and occlusion will look at the forces that area of the bite receives and let you know if surgery and crown lengthening procedures are your best avenue, or if the probability of saving that tooth is not worth the cost and extra procedures for a sometimes 50 percent success rate,” Crane said. “They also can determine if you are a candidate for an implant and whether it is cost-effective to place an implant that will last you the rest of your life.”

All of these procedures mentioned earlier are available to people who want to restore and keep their teeth, but in cases where “duck tape” no longer is a good option and replacing a tooth makes more sense for the long-term, it’s a good idea to consider dental implants.

Titanium used for knee and hip replacements is a good indication of how people today replace things that are worn out and have outlived their current usefulness. This technology enables patients to continue to experience active, successful lifestyles.

“The same can be said of dental implants,” he said. “You can replace what once was and have very successful results.”