Root Canal, Post, Core and Crown vs. Dental Implant

I am all about saving teeth.  And most of the other dentists are the same.  This is because we know that each tooth that is lost by the patient brings him one step closer to dentures. The dentures are the most horrific way of “having teeth”. One interesting fact about denture wearers is that they do not complain about their horrible lifestyle in dentures to anyone except the dentist. The family and close friends have no idea that the denture wearer is so unhappy.  The only person they complain to is the dentist.  So for some people who are losing their teeth, the future of being in dentures does not look too horrible because they know someone wearing dentures who “acts as happy as he can be”.

Now, the question that comes up a lot with patients is: Is it worth saving every single tooth by all means?  The answer is more complicated and delicate than an Yes and No answer.

In the past, before dental implants, it was worth saving all possible teeth by all means. Even buying couple more years for a tooth in the mouth was worth doing.  And it still is worth today, but today only for the teeth that are promising.  Only for the teeth that we know that they are going to be in the patient’s mouth for long, long time.

I’ll give a recent example.  A patient came to me for full mouth reconstruction. One specific tooth had a root canal and a crown on it. I would have loved to keep the tooth, but the root canal had a sign of slight infection. I sent the patient to an endodontist to just evaluate the tooth to see if it is worth saving.  I asked in my referral note to be called before he started any treatment. The endodontist just started the retreatment of the tooth. Patient came back to me still in pain from the retreatment.  He went back to the endodontist and he re retreated the tooth.  Patient still in pain. I called the head endodontist in that practice and told him about the issues. He saw the patient himself and re re retreated the tooth and then decided the patient needed periapical surgery.  He performed the periapical surgery and the patient is finally feeling a little better. But the patient is now saying it it was really worth doing all this when the endodontic office charged him every single time: 2 retreatments and the periapical surgery.  So this tooth had overall three root canals, one periapical surgery and one crown. What is the future of this tooth being patched so many times?  After investing approx. $5000 in this tooth, the patient has a tooth that is most likely to come out or create other problems. Was it worth saving the tooth by all means. In this case no. With that amount of aggravation and financial burden, absolutely no. He patient could have had the implant done and have that guaranteed for the rest of his life with no problems. This is why I initially asked in my referral note to evaluate the tooth and call me. The endodontist just started the work “hoping for the best”.

The conclusion is that sometimes  is not worth saving teeth by all means when we anticipate that the results are not long lasting.  Sometimes it is just better to choose the simpler way of dental implants. They are more predictable than a re re re retreated tooth. And cheaper. And less aggravating.

If you have any questions please call my office, Sewell Dental Arts at 856-582-2220. I will be happy to answer your questions and help you.