Monday, February 25, 2008

Endodontic Retreatment or Implant?

This patient is wondering if she would be better off having tooth #10 extracted and an implant placed.

This is her situation. She had this silver point root canal done back in the 70's. A new crown was placed about a month ago and then the crown broke off. She came to my office for an evaluation. I recommended that we retreat the root canal, and place a new post for retention of the build-up/crown.

Since the crown broke off the remaining tooth structure supporting it, the ideal situation would be to make a new crown and improve the ferrrule effect.

I explained to her that as long as the tooth is not fractured, the retention of the natural tooth will actually help maintain the bone in the esthetic zone and give her the most natural appearance.

The silver point root canal is almost 40 years old. There is no sign of failure of the endodontics. This is actually a restorative failure. Any disturbance of the silver point can jeopardize it's seal. In retrospect, it would have been best to have retreated the RCT and placed a new post and core prior to the new crown.

4 comments:

Ian Furst said...

Dear Jason & Edward,
Great clinical site! Re #10 - if there is absolutely no sign of fracture after the crown broke off I agree but I'd have a very high index of suspicion for VRF. Also there seems to be some voids in the filler/GP on the distol aspect at the midroot point which would give me pause for concern. I've started a new blog at www.waittimes.blogspot.com on techniques for minimizing wait times in high utilization practices (both medical and dental). Any feedback you could provide would be appreciated and if there's anyway you can mention or link to it on you're website I'd appreciate it. Thanks Ian

Ameloblast said...

A retreatment would address the identification of a vertical root fracture and hopefully any obturation voids.

Jason: Are you concerned about an esthetic concern if the restorative dentist tries to capture more ferrule on the labial aspect of the prep? ie. recession, long crown, etc.

Jason J. Hales D.D.S., M.S. said...

The crown margin is still 1-2 mm above the crestal bone. I would assume the restorative dentist could drop the margin and improve the ferrule.
If you take the tooth out, you can expect the crestal bone to drop.
Of course you could also use orthodontics to extrude the tooth.
I just find it interesting how quick some people are to pull a tooth and place an implant.

Anonymous said...

there is no sign of failuer of the root canal priviously done you should not remove the tooth go for retreatment post&core drop the crown margin to improve the ferrule.i also would not suggest extrusion of tooth