If you have a root canal and now need a dental implant there are some very important issues to be aware of. This is especially important if the tooth to be extracted is in the upper front area. It will have consequences on the final result and cosmetic appearance of the implant.
A previous failed root canal can be a major detriment to having an implant. The problem is related to a hole that develops in your bone which dissolves the very thin outer wall of bone.
Although root canals work, they are not 100% effective. Some teeth may not respond as expected to the root canal therapy. Sometimes, it is clear from the beginning that the root canal is not working as planned. Other times, it may be years later that a problem arises.
The problem is usually re-infection of the root canal or a broken, fractured root. This usually shows up as a painful pimple on your gums.
Often times a root canal is “re-done” if the root becomes re-infected. I have seen patients that have had the same root canal done 2-5 times before finally
extracting the tooth and having a dental implant!
The infection causes bone loss to occur around the root where you would need bone for a dental implant.
An apicoectomy, or “reverse root canal,” is sometimes done as a last ditch effort to save an almost hopeless tooth with a root canal. It does not have a very high long-term documented success rate. You have about a 40% chance of losing the tooth in 5 years.
The Procedure: Surgical access is made through the bone, and the tip or apex of the root can then usually be seen through this “window” in the bone. The tip of the root is cut off, and a sealing filling is placed at the end of the root.
Examples:
That is where the problem occurs. The hole made in the bone to do the procedure does not always heal leaving a defect under your nose if it is in the upper front.
This CT scan image of my patient that I treated in my office in Burbank shows this exactly:
Although, this hole is correctable, it usually requires a more extensive bone graft to correct. This increases the cost and time to have the dental implant.
The worst case scenario is where the “apico” fails and the entire outer bone wall is lost. This usually requires and onlay block type bone graft taken from your chin or the side of your jaw to correct.
My recommendations…look at all your options and plan for the long-term. Saving a hopeless tooth may in fact be more problematic and costly than extracting and maybe having a same day immediate implant.
Please feel free to comment or ask questions in the comments section below.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com
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That’s really interesting. Thanks for the info.
Hi,
Can I please ask a question.
Ive had a Apicoectomy 10 weeks ago, i go to the cons in november to findout if it worked, but would i know now really if it worked? if i had pain?
Also if i needed to have my tooth taken out(front) how long do i need to wait till i can have a bridge?
Thank you lots
Hi Kristina,
Generally an x-ray will be taken several months later to check the healing. The dentist will check the gums in the area also. A failed apicoectomy may not have pain so give it some time.
If you need to remove the tooth, a same day temporary bridge can be made. You will wear that for a few weeks, then the final molds can be made for the real bridge or implant crown.
Hello Dr. Amin: My top front tooth ‘died’ over 30 years ago. The tooth was bleached 2x and eventually I had root canal work, post and crown, all which lasted many years. Most recently the tooth became loose and fell out. One dentist said the work on the root canal did not go deep enough making the post too short and not as strong as it could have been. I am having conflicting information regarding a new root canal. One dentist said I do not need a new root canal as the tooth already had one. Would you recommend I re-do the root canal, post and crown or should I think about an implant?
Thank you for your time and consideration,
Margaret
Hi Margaret,
30 years is a excellent life span for a dead tooth!
Retreating the root canal vs. a dental implant is a difficult decision sometimes.
It depends how much of your original tooth is still present to hold a new crown and how healthy the root is.
Without seeing you and an x-ray, I can’t give you an educated response.
Consider seeing an endodontist for an opinion.
I hope this helps! Let me know if you need anything else!
Respectfully,
Dr. Amin
Hello, I came across this in a google search- I just had my first root canal done (it’s my right lateral incisor), and I’m only 25. I went in for my first checkup on it today, and my endodontist told me that it doesn’t seem like it’s healing well (it’s “very stable” he said, but the bone isn’t healing as much as he’d like, and I’ve also had NO pain, swelling, or infection since it was done). He told me to come back in 9 months (a year from when it was done), and if it still hasn’t healed better then I will need a bone graft… is there any other way to take care of it? A bone graft sounds pretty serious. Or is there anything I can do to make my bone “heal better?” I have no clue what to do. Thank you!
Hi Emily,
Don’t fret just yet. Most root canals that are well done, heal great. They need a lot of time to heal though. Lateral incisors usually heal really well with complete bone fill. Give it about a year.
It’s the molars that cause the biggest issues! It should be fine!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Website ~ http://www.burbankdentalimplants.com
Blog ~ http://www.dentalimplantdentistryblog.com
818-846-3203 — Burbank, California
I had a apicoectomy done to me about 5 wek ago because of tooth infection didn’t go away. It’s have been 5 weeks and after I stoped taking the antibiotis my upper lip began to swollen and the right side of my nose. I’m going to see the the dentist Tuesday. Is s the extraction of the tooth wiil help to get rid off the infection.
Thank you!
Hi Henry,
What did your dentist say at your appointment on Tuesday?
Dr. Amin
I have been told I have to have a root canal on #19. I am also experiencing pain below my jaw and into my neck could this be from the bad tooth?
It is very possible! Yes!
Hello Dr Amin,
I just had an apicoectomy, about 20 days ago. I do not have any pain and the tooth feels good, but a pimple developed right after my stitches were removed, about two weeks ago. I took antibiotics for a couple of days and the pimple went away, but now is back. Its not necessarily painful, I can eat normally, but I am afraid about what this may be.
Thank you in advance.
Hi Carina,
It is possible that there is a problem. I would see your dentist asap.
Dr. Ramsey Amin
Burbank Dental Implant Dentist
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Website ~ http://www.burbankdentalimplants.com
Visit My Blog ~ http://www.dentalimplantdentistryblog.com
818-846-3203
I had an epicoectomy done to a tooth on the lower right quadrin, not the eye tooth, but the one after that located toward the back, but is not a molar back in 2002/03.
Over the past year, that tooth has been sensitive, and mildly painful. In the past year, twice I’ve had swelling on the outside of the jawline about the size of an egg,thus swelling on the face. It’s painful, I can’t chew on that side….eventually the swelling goes down. I’ve had no insurance for 2 1/2 years…..I don’t want to wait until an emergency happens……what do you think.
Sincerely,
Diane
Hi Diane,
Consider seeing an endodontist for an opinion asap.
It could even be another tooth!
Dont wait on this.
Respectfully,
Dr. Amin
I have had an crown chipped in back of my mouth on top of root canal, I need to know as far as cost efficient, should I just get an implant vs redo of an root canal and crown
Hi Emerson,
Re-doing a root canal should be carefully determined by a dentist. There is no way for me to tell you this based on your question alone. You must be examined.
Hi Dr Amin:
After an accident, I had 4 root canals performed on my upper front teeth. This was 4.5 years ago. About 3 weeks ago my palate behind one of my front teeth felt sore… nothing unbearable but i was aware of tenderness. today i’ve got a bump on the palate edged up behind my tooth. could this be a failed root canal so many years later? i’m terrified i’ve let something go (even though my symptoms are very recent) and i’ll lose my tooth (oh and i’m still paying off my veneers!). thank you for any information. it will ease my mind.
Hi Colleen,
Sorry for the delay in my reply.
Yes, the bump behind the tooth you mention may be a failure or it may be a localized gum problem.
Get to a good dentist asap!
Dr. Amin
I have a question, I’m 26 years old, I had two root canals and two crowns put on my two front teeth when i was 14 due to a fall that happened. Well, I just went to the dentist and they told me i need a root canal and a apicoectomy and a bone graph. The tooth that needs the root canal is the anterior tooth to the right on my front tooth. My question is, Should i have this done, and have implants done or should i try this and hope for the best? I’m so scared and lost as to why this has occured. I’m young and have two young children ,this is so not fair
Hi Alicia,
Without seeing you, I could not tell you exactly. Ask your dentist what they would do in their own mouth.
Ask what is the long-term prognosis of your particular teeth.
Ask if they feel implants may be better.
Good Luck,
Dr. Amin
I have had two different crowns, then two root canals on a lower middle tooth. Lastly, I needed an apicoectomy done because the dentist left a piece of the drill bit in the root canal which became infected and formed a cyst. Now, a year and a half later, I have intense swelling in the gum. I have been advised to take antibiotics and go in Monday for x-rays to see what my options are. Do you have any foresight or recommendations for me?
Hi, Today I had my front #10 tooth extracted in preparation for an implant after the tooth became reinfected (it was previously root-canaled a dozen years ago).
Upon extraction today, my oral surgeon said I’ve lost a lot of bone from the infection and that the chances for implant success are now low — he still used an artificial graft material — but said he thinks I will mostly likely need a bridge.
After reading through your posts today I feel like he is not giving me full options on other means by which to build up the bone for an implant. Are there other grafting options you can suggest for me to ask him or another surgeon about?
I am a healthy 33 year-old, non-smoker, with no other dental or bone issues past or present.
Thank you
Hi Caleb,
Tooth #10 area is generally easy and sucessful to rebuild. I usally do block onlay grafting or GBR (guided bone regeneration)in my practice in Burbank to get the best outcomes.
What is going on with the teeth right next to #10? Any crowns or bone loss?
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Hi Dr,
I m in NJ.
Is there an email id i can drop you a mail at? As i would like to send you my x-rays while i explain you the state of my tooth. Please do reply to the email id provided herewith.
- Mohana M
Hi Mohana,
I would need to see you in person to do a full evaluation. X-rays alone does not give me enough information to help you properly.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
818-846-3203
I have a tooth that was root canalled a long time ago.
last december i had an apicoectomy on the tooth.
the infection returned, so this past july the oral surgeon performed another apicoectomy. the infection has again returned.
i want desparately to save the tooth, if possible.
may a root canal be performed after an apicoectomy?
should i have seen an endodontist, rather than an oral surgeon for the apicoectomy?
thank you.
i also wanted to mention that the abscess gets larger when i eat and drink,
and decreases in size if i avoid eating and drinking.
I failed to mention that the abscess gets bigger when I eat and drink and smaller when i dont.
i asked the surgeon why, but he said he didnt know.
Hi Orrie,
After an apicoectomy, the tooth should be doing ok “IF” it works. You may lose the tooth and end up needing an implant in the very near future. If so, some degree of bone grafting will probably be needed too.
Respecfully,
Dr. Amin
Hi Dr. Amin,
I went in for a root canal (on #23) that was not able to be completed due to calcification near the root of the tooth. There has been some bone loss but the tooth is still stable and shows no signs of deep pockets around the gum line. I have been told that the next step would be to do an Apicoectomy with a bone graft (osteo graf) in the attempt to try to save the tooth but that there is no way to tell whether it can be performed/completed until the gums are pulled back (from eye tooth, to eye tooth).
I’m not really questioning the Apicoectomy at this point after reading up on what it is for, but about the fact that the need for the gums from the eye tooth, to the other eye tooth needs to be pulled back — For one tooth, does that much truly need to be removed, in order to get to the root of the #23 tooth?
Thank you for having this site and being willing to help all of us who are having to make such difficult decisions on what to do!
Hi Jen,
Sometimes in order to access even one tooth, the incision has to be as long as six teeth. It is important that the dentist can access and see the area very well before doing anything.
That being said, there are different surgical approaches that vary by the dentist’s their training, judgment and experience.
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry