Dr. Achanta Krishna Swaroop
Dentistry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a fractured front tooth 20 years ago, which was treated by a dentist with a root canal procedure, adding a post, and placing a crown on the tooth.
Today, I underwent a cone beam dental scan, which indicates a possible infection in the root canal-treated tooth.
Is there indeed an infection, and is it considered urgent?
What is the most effective method to address this issue? Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I am the oral surgeon providing expert opinion on your case. As previously explained, there is indeed an infection of moderate severity is present. Given that the tooth is not loose or mobile, a repeat root canal procedure would likely suffice. However, if you prefer an alternative approach, you could consider antibiotic treatment for a continuous three to five-day period to see if it resolves the infection.
As previously detailed, the optimal solution for addressing this issue is through repeat root canal treatment, which involves removing the previous root canal filling material. Extraction should be avoided unless necessary.
Ultimately, the decision between a repeat root canal and extraction is a matter of convenience. While extraction followed by immediate implantation may seem like a simpler option, it is important to consider that you would be losing a structurally sound tooth with only a mild infection.
If you have any further questions about antibiotic prophylaxis or if you are still unsure about proceeding with extraction, please feel free to ask. The recommended course of action remains a repeat root canal treatment.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
The tooth in question has undergone a root canal procedure and has a post for additional support due to being over-prepped. The dentist who conducted the scan advises against root resection or endodontic revision, citing the presence of the post and a high probability of failure with these procedures. Instead, they recommend removing the tooth and replacing it with an implant for the best long-term outcome. What is your professional opinion on this matter?
Thank you.
Hello,
Welcome back to icliniq.com.
If your dentist has classified the infection as moderate, it might be prudent to seek another opinion from a professional oral surgeon for further evaluation. Dentists typically do not highlight potential failure chances without reason. In the case of a front tooth, there may be concerns about the success of a repeat root canal procedure.
Considering the importance of minimizing risks, it could be advisable to heed their advice and proceed with extraction. However, opting for immediate implant placement following extraction can mitigate potential bone-related complications. As a surgeon, this would be my recommendation.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I plan to seek a second opinion at another clinic to confirm my decision. However, if I opt for the implant route, should I ensure the procedure involves immediate implant placement rather than extracting the tooth and waiting several months for implantation? Is this the correct approach?
Thank you.
Hello,
Welcome back to icliniq.com.
Immediate implants prevent any potential bone loss, ensuring firm bone formation around the implant within ideally three months. Following the same-day extraction, the implant is promptly placed, and a temporary crown is fitted. After three to four months, a permanent crown is installed over the implant.
Additionally, it is advisable to consult a qualified surgeon for a thorough second opinion at the clinic. One can choose to save the tooth if it can be saved with a good prognosis and minimal risk. However, if extraction is necessary, proceeding with the immediate implant is recommended.
Best of luck with your decision. Feel free to reach out with any questions or share insights from your in-clinic second opinion for further confirmation.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
It is incredibly nerve-wracking and stressful. Why is it that some surgeons do same-day implant and extraction while others make you wait a few months before placing the implant? Also, if I do extraction and same-day implant, what is the best way to clean out the infection properly?
Thank you.
Hello,
Welcome back to icliniq.
Immediate implants offer optimal outcomes. A skilled maxillofacial surgeon can swiftly perform the necessary cleaning and implant placement within minutes, with minimal complications. All that is required is a detailed CBCT (cone beam computed tomography) scan. There is no need for concern to proceed confidently. I am glad to have assisted.
I hope this information will help you.
Thank you.
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Dentistry
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