Infected Root Canal - Implant needed?

[happygirl0612]

Hello,
I am so confused about what to do with my tooth.
Last year in April 2013 i had a root canal done on tooth # 30. I waited a little over a year to get a crown. In august 2014 i did a crown and ever since have been having issues with that tooth. First it started with sensitivity to heat and then after the dentist performed a bite adjustment, i started having sensitivity to cold which still continues to date.
I went back and saw Endodontist there who told me that x-ray shows a possible infection on the bottom of the root canal and the only 2 options that i have are apicoectomy or implant.

I read a lot about it and dont think apicoectomy will be good for me in a long run. I dont want to leave a dead tooth inside that is prone to the infection. I am young (29) and dont want to come to the same issue years later. So at this point i am considering an implant.
I read a lot about implants and currently there are 2 that are on the market, titanium and zirconium.
I would prefer a zirconium (metal free) implant and based on what i have seen so far, it seems to be a safer more natural choice.

Is that possible that infection developed AFTER the crown was placed? Why is that? The x-rays taken before the crown dont show anything.
What do i do now?

 

[Dr. Garrett Fiorenza]

As far as the root canal is concerned, it is hard to say by just looking at these 2 xrays what has been going on with this tooth in the long term. It is unlikely that the infection happened after the crown was placed. If you waited over a year to get the crown chances are the infection was there and you just didn't have any symptoms.

I would get a consultation with an oral surgeon to talk about the costs involved in getting this tooth taken out and replaced with an implant. Then compare that with the cost of an apicoectomy. You will find that apicoectomies are expensive, but not as expensive as an implant. The thing to realize is even if you get the apicoectomy then 10 years from now you could still need an implant. On the other hand, if you get an implant (which have a 96% success rate) chances are you'll have it for the rest of your life.

Now, titanium implants are the standard right now. They have the longest track record and are very successful. I would go with titanium. Hope this helps,

Garrett Fiorenza, DDS
www.fiorenzadentalgroup.com
Greenwood, IN

 

[happygirl0612]

Thank you so much for your reply! I know the cost is high for both, but my main goal is to find the BEST solution for my overall health and i am willing to spend the money needed for whatever procedure.

Is it true that apicoectomy does not guarantee that the root canal will stay infection free for all my life and that is just the matter of time until it gets infected?

Also, even though titanium implants have been longer on the market, i read many positive things about zirconium implants. Why are they NOT more used by dentists? Are there anything i should be concerned about when it comes to them?

 

[Dr. Garrett Fiorenza]

Apicoectomies can last your whole life. However, since you've already gotten an infection in that tooth after the root canal it lowers the long term prognosis. So in your case I would be willing to bet that at some point down the line that tooth will get an infection or other complication after you do the apicoectomy.

Dentists use titanium more because of it's track record. These implants have been studied and have long term success rates of over 90%, even going out 20-30 years. With the zirconium implants dentists don't know for sure how they will last long term. Just personally, if I were looking for the best option for long term success I would go with titanium since it has that long term success rate that's been confirmed over and over again. Hope this help,

Garrett Fiorenza, DDS
www.fiorenzadentalgroup.com
Greenwood, IN

 

[happygirl0612]

Thank you so much for your reply!
I do understand that titanium has a proven record for lasting a long time. However, aren't dentists concerned with what impact it may have on the patient's overall health? What about titanium corroding in the mouth or affecting your immune system and creating autoimmune issues?
Its not just the matter of being durable and lasting, it is also so important to consider other long term effect on health and such. I want to have a tooth that not only lasts but also doesn't harm my health! To me that is probably even more important.
I have read so many scary things online when people complained how titanium implants have affected their health negatively!

Besides the durability, lasting and lack of research , do you have any other major concerns for ceramic implants?

Also, is there any test that can be done to prove that i am not allergic to the titanium metal, etc?

I am guessing outside of just implant & apicoectomy, i have no other viable options, correct?
thank you!!

 

[Dr. Garrett Fiorenza]

No there's no negative effect the zirconium would have besides for a lack of track record. Remember though that titanium is inert and is perfectly safe, that's why doctors use it on hip and knee replacements. But if that is a worry for you then zirconium is a viable alternative.

I'm sure you could contact a specialist to see if you are allergic to titanium, although titanium allergies are incredibly rare.

You could also have a dental bridge placed. This is a slightly older technology for replacing teeth. They would put crowns on the teeth on either side of the missing tooth, and put a fake tooth (just the top part, no root) in the space. They are a good option for replacing a missing tooth, but implants are far better.

Garrett Fiorenza, DDS
www.fiorenzadentalgroup.com

 

[happygirl0612]

Thanks so much for the info!

I definitely dont want a bridge since it may negatively affect other teeth in the long run since they get affected. So i guess the only viable option for me is to have an implant.

The reason why i was concerned about getting a zirconia implant (outside of its short track record) was that i read they may have isotopes in them! That is really scary to me! Do you know anything about that?

Also, what can happen in the worst case scenario with zirconia implant, it breaks and it has to be replaced? Is that all that can happen? I read that they are just as durable if not more as titanium.

thank you.

 

[Dr. Garrett Fiorenza]

I'm not familiar with isotopes in zirconia implants. You're right the worst case is that it breaks and you have to get it removed and replaced.

 

[Dentgr]

I believe there's a second distal root that is not treated.(i can see 2 lamina dura at the distal root). Check it with an endodontist before you proceed with other options.

 

[happygirl0612]

I believe there's a second distal root that is not treated.(i can see 2 lamina dura at the distal root). Check it with an endodontist before you proceed with other options.

Thank you for your reply! I happened to see an oral surgeon today who told me that implant may not be necessary and he also suggested to check with experienced Endodontist. He suggested to do a 3D scan that should show more the condition of the tooth. My symptoms are sporadic and mild and upon his exam today, i showed NO signs of discomfort. from time to time i feel sensitivity to cold.
What success rate would a repeat root canal have?
Is it same thing as epicoectomy or something else?

thanks!

 

[Dentgr]

Thank you for your reply! I happened to see an oral surgeon today who told me that implant may not be necessary and he also suggested to check with experienced Endodontist. He suggested to do a 3D scan that should show more the condition of the tooth. My symptoms are sporadic and mild and upon his exam today, i showed NO signs of discomfort. from time to time i feel sensitivity to cold.
What success rate would a repeat root canal have?
Is it same thing as epicoectomy or something else?

thanks!

Root canal retreatment success rate varies. In your case ,if there's a missed canal, it's very high(about 95%). He will though remove the crown and post buildup to access the extra canal. In my opinion it's worth to give it a try. There's nothing like our own teeth!
Molars like this usually have 3 canals. Under the microscope I've found up to 5!(in bibliography I've seen even 6 of them!)
So give it a chance.
Apicoectomy is a different procedure. Retreatment procedure is like the treatment you had in the first place.
...apologies for my English but I'm not from an English speaking country....