Dental Root Amputations: Basic Information
A patient needs to have a root canal when the nerve inside the tooth has died or is dying. First, the space of the nerve and blood vessels in the middle of the tooth is cleaned out with mechanical files and irrigation with chemicals. Once the space is cleaned up, a filling material is placed in the space. This material is usually gutta percha – which is also the material inside golf balls!
Difficult Root Canals
Sometimes the canal can have a shape with lots of bends and curves. This makes it more difficult to clean up. The goal is a high quality root canal with all the nerve matter cleaned out. And new instrumentation and CT scans make it easier for the root canal specialist (endodontist) to accomplish this. However unfortunately, sometimes curvy canals can make it difficult or impossible to get everything cleaned out. The residual organic matter can cause a chronic low grade infection which can be seen on an x-ray, and the result is the bone around the end of the root deteriorates and creates a problem.
On front teeth, a surgical procedure can be performed to remove the tip of the root and place a special filling material to help the area heal. This procedure is known as an apicoectomy (apex=end of the root, and -ectomy+to remove). The method is highly successful.
More Root Canal Problems
In the molar area where there are two or three roots, the root can be cut off Then the surface toward the bone is smoothed for good healing. As a rule, these last only five to ten years. With the new technology this should happen less frequently. But with older root canals the end of the root can develop a problem of low grade infection growing at the end of the root.
I have a patient who had this procedure done over 20 years ago. The tissue was chronically sore in that area. He finally had this tooth removed (an upper first molar). Now he is planning on having a dental implant placed.
Just a week ago I saw a patient who also has a root amputation. He was having more discomfort because the natural tooth broke under an existing crown. He has had the tooth removed and bone grafting performed. This is in preparation for the implant he will have placed in the coming year.
Alternatives to Root Canals
At this point in time, I try to steer patients away from root amputations. I believe the technology of implants has improved so much that getting a single tooth implant is the way to go. Even a regular root canal tooth with a crown on it can experience a problem down the road. An example of a root canal difficulty is the natural tooth breaking under the crown. And that’s with the tooth structure relatively intact.
30 years ago saving the tooth, even for a shorter time, was in vogue in the dental community. This is no longer the case with the advent of advanced technology of implants.
Call us at Lohmann Dental if your would like a free consultation on your personal situation.
William Lohmann DDS