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© 2017 Care Endodontics Chicago/Julianne Carrara DMD MS LTD

Non Endodontic Restorative Options

Implants and Tooth Replacement Options

Root canal treatmentretreatment or endodontic surgery may all be ways to help you save your tooth. Sometimes, however, a tooth cannot be saved, and will need to be extracted and replaced with a prosthetic, or artificial, tooth. You should talk to an endodontist about all of your options to save your natural tooth before choosing to have a tooth extracted.  

What are the alternatives to endodontic treatment?

Though endodontic procedures are intended to help save your tooth, this is not always possible. Often, the only alternative to endodontic treatment is extraction of the tooth. Missing teeth can make you self-conscious, affect your ability to bite and chew, cause other healthy teeth to shift and have a negative impact on your overall health. For these reasons, the extracted tooth should be replaced with an artificial one.

What is a dental implant?

Implants are a state-of-the-art replacement for missing teeth. A dental implant is an artificial tooth root placed into your jaw to hold a replacement tooth – the crown - in place. The implant emulates the shape of the root and is usually made of titanium and other materials that are well-suited to the human body. The implant is surgically placed into the jaw and incorporates into the bone over time to become a stable base for crowns. Dental implants have been used for several decades by patients of all ages. They can replace a single tooth, several teeth or support partial or full dentures. 

 

What’s involved in placing an implant?

The way implants are placed depends on the patient, the type of implant and the tooth being replaced. Some implants can be fully placed in one day. Most implants involve two or three steps. First, the implant is placed into the jaw and the gum is secured over the implant. Over the next three to six months the implant will fuse with the jaw bone. Once the implant and bone have bonded together, the dentist or specialist may attach an extension, called an abutment, to the implant. In some cases, the implant and abutment are a single unit placed during the initial surgery. In others, a second surgery may be needed to attach the abutment to the replacement teeth. Once healed, the implant and abutment act as the foundation for the new tooth. In the final step, the dentist or specialist makes a crown in the right size, shape and color to match your natural teeth. The crown is attached to the implant post.

Dental implants provide a good alternative for the natural tooth when it must be extracted. Candidates for implants should have good general and oral health, adequate bone support in the jaw and healthy gum tissues. Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery and prevent successful placement of an implant. Other risk factors for implant placement can include smoking, poor bone quality, long-term use of bisphosphonate medications, and low estrogen levels.

Replacing a missing or diseased tooth with an implant has several advantages:

  • Natural appearance

  • Don’t require dental procedures on neighboring teeth

  • Reliable

Though nothing looks, feels or functions exactly like your natural tooth, dental implants are a viable alternative to help you maintain a beautiful smile.

 

Are there any other options?

For replacement of an extracted tooth, you may also consider a bridge or removable partial denture. These options require additional dental procedures on adjacent healthy teeth, and should be discussed with your dentist or specialist.

  

Who performs the procedures?

All dentists, including your general dentist, received training in endodontic treatment and dental implants in dental school. General dentists can perform these procedures, but often they refer patients with diseased teeth to endodontists for evaluation and treatment.

Endodontists are dentists with special training in endodontic procedures. They focus on endodontics in their practices because they are specialists. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics. They perform routine as well as difficult and very complex endodontic procedures, including endodontic surgery. Many endodontists have also received additional training in the placement of dental implants, and can perform this procedure for patients whose teeth cannot be saved. 

Your dentist may have referred you to an endodontic specialist because of a personal concern about your medical conditions, treatment preferences, pain tolerance and/or the overall high quality of your dental care. The endodontist is a valuable partner on your general dentist’s team of trusted caregivers, and is no different than medical specialists who provide expert advice for heart, bone or other health problems. Endodontists are uniquely qualified to evaluate whether your tooth can be saved, and which option is best for you. 

 

How do I make a choice?

Research has proven that endodontic treatment and dental implants are equally successful. Therefore, it makes sense to start by trying to save your natural tooth – nothing looks, feels or functions like it. If, for whatever reason, healing does not occur, then treatment with a dental implant is an excellent backup plan.

Ultimately, your treatment decision should be based on a strategy you have discussed with your dental team (your dentist, endodontist and/or other specialists), and that you agree is best for your overall health.

 

Traumatic Injuries

Not Always about Brushing and Flossing

Traumatic dental injuries often occur in accidents or sports-related injuries.

 

Chipped teeth account for the majority of all dental injuries. 

 

Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries.

 

Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam. Endodontists are dentists who specialize in treating traumatic dental injuries. With their advanced skills, techniques and technologies they can often save injured teeth. If you have a cracked or injured tooth, find an endodontist near you right away!  Most endodontists offer tremendous flexibility in accommodating emergency cases including weekends in some cases so your pain can be relieved quickly.

Chipped Teeth

Not Involve the Nerve

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.

Dislodged or Luxated Teeth

Teeth that Move from Position

During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.

Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.

Knocked Out or Avulsed

Immediate Action is Best

If a tooth is completely knocked out of your mouth, time is of the essence. See an endodontist or dentist immediately!

 

Handle the knocked-out tooth very gently, avoiding touching the root surface and follow these steps to protect the tooth.  

Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.

Will the tooth need any special care or additional treatment?

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.

Root Fractures

Below the Surface

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.

Will the tooth need any special care or additional treatment?

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.

Injuries to Children

Lifetime of Dental Exams

Do traumatic dental injuries differ in children?

Chipped primary (baby) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.

Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or endodontist to stimulate continued root growth.

Endodontists have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontists will do all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.

Will the tooth need any special care or additional treatment?

The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.

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