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Infected Root Canals/ Molar Implants

Molars are the most common teeth to have a dental implant. It makes sense because we use the last molars more than any of our teeth for primary chewing.

Why Do Root Canals get Infected?

Most often molars are replaced from a root canal that did not work. The root canal tooth can crack or there is just not enough tooth to hold the crown on so it ends up being extracted. Sometimes a chronic infection is present around the end of the root canal because the crown leaks at the margin edge. This can be inflammation or infection and can change.

infected root canal x-ray
Infected root canal x-ray

There is a skill an art to replacing molars especially the last 2 molars.

The tooth numbers for the molars are #2, #3, #14, #15, #18, #19, #30 and #31. This does not count the wisdom teeth #1, 16, 17, 32.

Last molar dental implants can look really fake and can have problems like bone loss early on. In my practice I have a unique skill set that allows me to replace 90% of the molars that I extract on the same day of the removal!

Immediate Implants For Molars

The time saved by having any immediate same day last molar replacement is usually about 4 months. This technique gets you into a tooth faster than the traditional extract, socket bone graft and wait method. Both methods have their merits and I do both.

x-ray immediate molar
X-ray immediate molar guide pin to replace failed root canal. X-ray taken during surgery
x-ray molar dental implant
X-ray molar dental implant after restored with custom abutments and crown with good emergence

If the tooth does have infection it is very important that the infection is cleaned out all the way. Antibiotics are almost always needed at least before the surgery. The infection needs to be physically debrided out of the area and I often treat it with a special antiseptic directly on the bone to clear that out as well

The implant is typically placed in the middle between the roots. Because the implant is purposely smaller than the original tooth, a bone graft almost always needs to be placed into the void created between the implant and the socket walls.

Replacing molars on the same day of extraction requires a much higher degree of skill, experience and judgment. On the lower jaw a nerve is close by. In my practice I use some specialized instrumentation such as piezo electric surgery and osseodensification to make the procedure safe.

The biggest advantage to the same day replacement of the molar is that it saves time, money and yields the best or better result than a delayed replacement. By placing the implant on the same day the bone never gets a chance to shrink by disuse atrophy.

A method that I use to carefully control the shrinkage is by making a custom contoured healing abutment. This is a specialized custom piece to seal off the socket. It holds in the bone graft and help prevent the gum from creating a big dent. It takes extra time during the surgery to make but I find it has a lot of value. It makes the molars look really nice and helps the bone growth substantially. Other times I will use a carbon dioxide laser to shape the gums.

x-ray custom healing abutment dental implant
x-ray of custom healing abutment dental implant
guide pin dental implant x-ray
Guidance pin to place dental implant in proper position
root canal failing x-ray
root canal failing x-ray

Most patients are sedated for this procedure as removing a molar is difficult. Root canal molars usually come out in many pieces! Just yesterday I took one out in about 23 pieces! Yikes

I hope this helps you decide what to do with your bad molar!

Respectfully,

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California

4 thoughts on “Infected Root Canals/ Molar Implants

  1. I am so sorry, I didn’t ask my main question. It is a choice of apico or extraction.
    My endo recommended an apico today, it would be a month before he can do it.
    My oral surgeon recommended #13 should be extracted because it is loose and fragile, and said to return to him should it become reinfected.

  2. I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    No antibiotic was prescribed today.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings. And still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research to decide asap.

    1. It sounds that based on your medical condition that extracting the tooth in its entirety may be best. Apicoectomy’s are more successful on teeth with single roots such as your front teeth. Tooth #13 has a double root and although it is possible it may not have the longevity you are looking for. If your truly immunocompromised and take immunosuppressant types of medications it does make dental implants more difficult. Your body has to integrate the implant to the bone through a process we call Osseo integration.

      I would hate for you to have an apicoectomy only to end up having the tooth extracted later on.

      A loose tooth will not be fixed by an apicoectomy. In order for an apicoectomy to be successful it really needs to be a very solid tooth.

      Good luck and stay safe during COVID 19

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  3. I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings.
    I still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research.

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About Ramsey Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.