I stumbled across this endo blog recently, and what perked my interest was the article on reRCT vs Implants.
http://www.theendoblog.com/2012/02/root-canal-retreatment-or-implant.html
Despite the obvious potential bias in the article, it does raise an important question. Do dentists discount endodontic retreatment in favour of an implant? And if so, why? Personally I would try and advocate endodontic retreatment in preference to implant placement (unless there are obvious contraindications). I firmly believe that a tooth with PDL attachments provide a superior structure when compared to a rigidly integrated implant. Also, humans are not perfect, and dental treatment does not last a lifetime in most cases. Should retreatment fail, there will always be the option of an implant later on.
What should we look for when considering endodontic retreatment?
- Restoreability – This may mean removal of the existing restoration to remove all decay and reassessing. A perfectly retreated tooth root is of no real use if there’s no tooth crown sitting on top of it!
- Adequacy – The existing root canal therapy would need to be assessed for the degree of preparation of the canals, for any inadequacies in either the apical or coronal seal and to locate untreated canals, if any.
- Pathology – larger PA lesions and long standing lesions will tend to have poorer prognosis than smaller and more recent lesions.
There are obviously other considerations that will contribute to a decision, and with the advent of cone-beam slices, we’re able to have more information at hand before making a final suggestion. A good and friendly endodontist is a godsend. We work with a really nice endodontist here in Sydney and he’s always been helpful in cases with which I’ve been uncertain.
Hopefully this will give you something to think about next time a failed RCT comes your way and extraction is the first thought that comes to mind…
