Throughout this last year
I had the opportunity to work as a dental assistant at a busy, privately owned practice.
Commonly, I saw the stress diagnosing and treating root canals brought to the two
dentists I worked with.
Simplistically said, when
a patient receives a root canal, the old nerves in the roots of the tooth are
drilled out, a disinfectant is used to clean the canal (usually bleach), and
then a material is used to fill in the roots. Root canals can be difficult for
dentists to do as every individual has different root anatomy. Most commonly,
individuals will have extra canals that the dentist has a hard time seeing, and
further, canals can differ in curvature making them hard to fill.
The problem with root
canals is that they should have success rates above 85%, unfortunately, many
are unsuccessful (1). I witnessed many patients that had failed root canals,
sometimes two years after they originally had treatment. Usually, when a root
canal fails, the dentist will try to “retreat” the tooth, essentially doing the
same steps they did the first time they completed the root canal. Retreatment
success rates are often less than the initial success rate. The majority of the
time, missed roots are the most common cause of a failed root canal. A study published in the Texas Dental Journal
found that almost 50% of root canals failed because of a missed canal (2). It is
also common for dentists to not completely treat the canals. When canals are
incompletely treated the filling material doesn't get all the way to the base
of the root and the bacteria cause the root canal to go bad.
General dentists do have
adequate training to complete root canals but endodontist often have better
success rates because of their additional schooling and equipment (1). Endodontists,
because they complete numerous root canals daily, usually invest in specialized
equipment such as 3D imaging machines that help ensure they find all of the
roots of a tooth (1). Many patients that receive root canals, or need a root
canal retreated, remain with general dentists for various reasons. Sometimes it
is cheaper for the patients, and often the dentist prefers not to refer their
patients as they want to keep them a part of their practice. It is a scary thought as many patients are uneducated in regards to oral health. As the
biotechnology industry grows, and more affordable equipment becomes available, hopefully many general
dentists will have better success in completing root canals. Until then, patients
need to be educated on the options they have for getting a root canal
completed or retreated.
1. Shelley
PQ. 2012. Does Root Canal Treatment Work [Online]. Elm Endodontics. http://www.elmendo.com/2012/01/do-root-canals-work/
2. Witherspoon
DE, Small JC, Regan JD. Missed canal systems are the most likely basis for
endodontic retreatment of molars. Texas Dental Journal. 130 (2): 127-139, 2013.
Emily,
ReplyDeleteThe International Endodontic Journal published an article examining the benefits of restoring a tooth through a root canal vs. implants and concluded that many factors play a role in deciding a treatment (root morphology, aesthetics, pre and post-operative treatment, etc.), but the two treatments had virtually the same success rates. Yes, dental implants are a much more costly and time consuming option, but the cost of implants are on the decline. Currently, implants are not covered by insurance plans which is the reason why this procedure is so expensive.
I was able to assist in an implant surgery and with as little as three visits, a patient was able to receive a brand new implant that fit the exact same shape and looked identical in color and shade to the other teeth.
If both treatments became equally priced, do you think that implants would ever replace root canal procedures? Creeping into the orthodontic field, if it could take less time, say 6 visits, to have a full mouth of implants that were perfectly straight and white than opting to undergo braces or Invisalign treatment, which have average treatment times of 18-24 months, would more people choose implants (if costs were equal)?
Reference:
Zitzmann NU, Krasti G, Hecker H, Walter C, Weiger R. Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. International Endodontic Journal: 1-18, 2009.
Scott,
ReplyDeleteI really do think that if implants were the same cost as a root canal people would opt for that choice. It seems that root canals, with how many fail, aren't the "perfect" treatment option. Further, even after many people get root canals and retreated root canals, they still need a crown! After sitting in the chair multiple times to receive all that treatment they could have an implant that is essentially a better, long lasting option. Root canals seem so difficult because of the variety in individual tooth anatomy. Extracting the tooth and providing an implant essentially eliminates that problem.
Also, I think implants may be an option in full mouth restorations. Today when people get full mouth restorations veneers or crowns are put over their teeth to reshape, align, and recolor their smile. One problem with full mouth restorations is that you are "agitating" the tooth when you are grinding on it to place the crown/veneer. People sometimes need root canals down the road because of the effect agitation has on the tooth. If you provide the patient with an implant, instead of a veneer/crown, I would like to think it would be the preferred treatment method as it essentially eliminates the issue with root canals.
I agree orthodontia could also be effected by a decrease in implant price, although I don't know how much at this point. If a couple of teeth seem out of alignment, it may be a feasible option! Thanks for the comment, I enjoy your perspective!
This is a big ethical issue in the field of dentistry. While general dentists are capable of and licensed to perform root canals, if an endodontist can perform the surgery with a higher rate of success then a patient should be referred to a specialist. The difficulty of root canal procedures is often associated with which tooth is affected and the access to that tooth. If it is a premolar that offers easy access for the surgery then a general dentist may feel more comfortable performing the surgery, however a second or third molar in the back of the mouth is a much more difficult procedure given its location in the mouth and more complex root structure. I think that communication between the dentist and patient would be able to relieve the situation. A general dentist that communicates to their patient and lets them know the risks and benefits of the surgery, their experience with root canals, along with the options available for having a specialist do the surgery will have a patient that feels like they are in charge of their own treatment. Related to this is communicating to the patient different treatment options available to them. Implants are more expensive and entail more surgery but with a better success rate some cases may be better treated with this option. Comparatively root canals are less invasive, easier to perform, and cost less money, if it is perceived that a root canal surgery would be successful then it is more likely the better surgery to have. Again it all comes down to communicating with the patient about the benefits, risks, and outcomes of various procedures along with the advantages and disadvantages of having a specialist perform the surgery.
ReplyDeleteIf you have root canal treatment so you should go to endodontist. You know that endodontist treat better than general dentist. They complete root canal therapy daily.
ReplyDeleteRoot Canal Treatment in Jaipur