Mr LT Mathew J. Royal

Dental Implants and Root Canals: What are they and when would I need one? LT Mathew J. Royal, DC USN In today’s health and image conscious society, a higher priority has been placed on maintaining one’s teeth and oral health than in the past. Dental implants and root canal therapy are two options available to patients to help preserve overall oral health. What is a dental implant? A dental implant is a titanium fixture or screw that is surgically placed into the bone of the jaw to substitute for a missing tooth. Many factors determine if a patient is a good candidate for an implant. Two of the most important criteria are overall health and the amount of existing bone in the area where the implant is to be placed. Smoking is also a very important factor determining if a patient is a good candidate for implants. Smokers often have a decreased immune response as their bodies are unable to fight off infection as well or heal as quickly from surgical procedures as compared to non-smokers. Consequently, oral surgeons and periodontists, the dental specialists who place implants, will usually not perform surgical implant placement unless the patient is smoke-free for at least 90-120 days. Implants do have advantages over other methods of replacing missing teeth such as bridges and removable partial or complete dentures. In order to place a bridge, the teeth on either side of the missing tooth or teeth must be prepared for crowns as part of the procedure. Crown preparation could lead to future problems for these teeth. When a tooth is removed, the bone in the area of the missing tooth will start to shrink, just like a muscle will start to atrophy when it is not used. A benefit to having an implant is that it helps to maintain bone levels and prevent further bone loss or shrinkage in these areas. What is a root canal? A root canal is a procedure where the tissue inside the tooth is removed and the space that it once occupied is cleaned, shaped and filled with a restorative material. The tooth is then often crowned or capped if it is towards the back of the mouth. The tooth is essentially “dead” and should not respond to hot or cold sensation, but should continue to function normally. If tooth decay spreads close to or into the nerve of the tooth, then the tooth will often become symptomatic and usually require a root canal. Another situation where root canal therapy may be an option will include trauma to a tooth in which the nerve of the tooth has been damaged. If a tooth has had multiple dental procedures, the nerve of the tooth may become irritated or slowly start to die and eventually require a root canal. Also, a tooth can break down to the point where there is very little remaining tooth structure above the gum line. This tooth may require a root canal in order to place a post down into the root of the tooth to act as an anchor for a crown or a cap. So why would I have a root canal done instead of just getting the tooth pulled and an implant placed? There are several reasons why we want to save and maintain our natural teeth. Natural teeth have a ligament that surrounds the tooth and attaches it to the bone of the jaw. This ligament allows our body to judge how much force we require to bite down. Implants do not maintain this natural ligament and therefore we lose the ability to judge the force with which we bite down on the implant. Cosmetic or aesthetic concerns may be an issue as well. Our natural teeth are designed to be in harmonious contact and contour with the surrounding teeth and gum tissues. In some cases it might be difficult to establish these harmonious relationships with implants. Another major factor presently impacting one’s decision on treatment is cost and insurance. Currently, a majority of dental insurance will cover about 80-100% the cost of a root canal. Most dental insurance policies do not cover the cost of placing dental implants at this time. Yet another concern with implants is that they require a surgical procedure. The risks involved with any surgery apply such as infection, temporary or permanent nerve damage, and damage to the bone, jaw or gum tissues. Conventional or non-surgical root canal therapy does have some inherit risk involved, but not to the same degree as a surgical procedure. Every tooth and every situation is different, many factors will determine the treatment that has the best chance for success. Therefore, when given the option of having a root canal or removing a tooth to have an implant placed, make sure your dentist provides you with the risks and benefits of both procedures so you will be able to make an informed decision.