Archives for October 2020

How many times can I get a root canal on the same tooth?

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Six years ago, my dentist did a root canal on a top right molar. The tooth is hurting again, and I am worried that I will need a dental implant. Is it possible to save a tooth that already had a root canal? Can a tooth remain stable after a second root canal? Thanks. Rachel

Rachel,

A dentist can repeat root canal treatment on a tooth two or more times. But successive root canal treatments don’t always make sense.

Can Root Canal Treatment Be Repeated?

Although a dentist can do a second or third root canal treatment—or more—on a tooth, the results are unpredictable. Even the most skilled dentists can perform root canal treatment that fails.

Studies show that root canal treatment has an 86 – 98% success rate. But cleaning out the canals of a tooth can be tricky. If a dentist doesn’t thoroughly remove infected tooth pulp, the infection will be sealed in the tooth only to flare up later.

A molar tooth has three canals, but sometimes a tooth has a “hidden” fourth canal. Sometimes a canal will branch out at a right angle. And although a dentist uses tiny, flexible instruments, it can be difficult—if not impossible—to get the device into angled canals to remove the infection.

Although highly angled canals are rare, when they exist, the probability of needing a repeat root canal increases. Retreatment has a 50 – 75% success rate. And if a highly skilled dentist performed the first root canal treatment, a second one might not work.

What About Root Canal Surgery?

Diagram of the phases of a dental implant for a comparison to a partial denture.

Get a root canal second opinion before agreeing to an extraction and dental implant

Root canal surgery is also known as an apicoectomy. During the procedure, a dentist makes an opening in the bone, cuts off the infected root tip, and fills the end of the tooth. But if tooth roots are not readily accessible, the surgery is risky and can damage the lower jaw and lip nerve.

An extraction and dental implant are the last options. If you’re uncomfortable with your dentist’s skill level, you can seek a second opinion with a dentist who is skilled in root canal treatment. Or you can ask your dentist to refer you to an endodontist, a root canal specialist. If you’re anxious about future procedures, ask your dentist or endodontist about sedation options.

 

Dr. Steven Brooksher of Baton Rouge sponsors this post. Dr. Brooksher has advanced training in restorative dentistry.

My dental implants failed in five days

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In September, I received four dental implants for $1850 each. I was supposed to receive three more implants. But I have stopped the process because two of the five implants came out the five days after surgery. Should I be charged for two implants that failed? Is this a common occurrence or do I have good reason to distrust my dentist? Thank you. Sheldon from GA

 

Sheldon,

Authority Dental estimates that dental implants have a 5% failure rate. And most failures occur over months or years—not days. Half of your dental implants failed. You should not have to pay your dental for failed implants.

Why Do Dental Implants Fail?

Dental implants fail due to infection, shortcuts, cheap implant fixtures, premature restoration, and sometimes health reasons.

  • Infection – Poor-fitting implant fixtures allows bacteria to grow around the implants and cause an infection.
  • Diagnostic shortcuts – Successful dental implants require 3-D CT scans to reveal your bone structure and surrounding areas. The scans show if you need bone grafting and where to place your implants for the best results.
  • Cheap implant fixtures – Low-quality dental implants don’t last. And they can cause infection.
  • Incorrect implant placement – Implants placed in the wrong location can loosen and fail.
  • Premature restoration – If a dentist places dental crowns or dentures on implants before the implants fuse with the jawbone, they will fail.
  • Smoking – Smoking restricts your blood flow and inhibits the healing process. Healing time will be slower, or dental implants might have.
  • Medical condition – If you have uncontrolled diabetes or a medical condition that decreases your ability to heal, it can affect the success of your dental implants.

What to Do When Your Dental Implants Fail

Diagram of the phases of a dental implant for a comparison to a partial denture.

When your dentist plans carefully, a dental implant fuses with the bone and anchors a crown

When dental implants fail, it’s wise to get a second opinion. Look for a specialist or a dentist with a fellowship in a dental implant organization like the International Congress of Oral Implantologists or the American Academy of Implant Dentistry. If two of your four implants failed on the fifth day, you’re at risk of losing the remaining implants.

Ask your current dentist for your dental records and x-rays before scheduling an appointment with an implant specialist. Although your current dentist should willingly refund you for failed dental implants, other steps you can take include:

  • Ask your new dentist to communicate with your former dentist in requesting a refund.\
  • Report your current dentist to the state dental board
  • Hire a malpractice attorney

 

We hope that your dentist will promptly refund you without resistance. Best wishes on your dental implant recovery. We hope you can soon smile with relief.

 

In Baton Rouge, you can get a dental implant second opinion from Steven Brooksher, DDS. Dr. Brooksher is a Fellow of the International Congress of Oral Implantologists.

Is It Too Late for Dental Implants?

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After wearing dentures for 18 years, is it too late for dental implants? My dentures won’t stay in, and my entire experience with wearing them has been disappointing and frustrating. It’s almost time for new dentures, and if I can minimize my misery, I would love it. Thanks. Vera from Biloxi, MS

 

Vera,

No, it’s not too late for dental implants. There isn’t a limit on how many years you can wear dentures before you’re not a candidate for implants, but you’ll need to be patient with the process. We’ll explain.

Dentures and Jawbone Resorption

The longer you wear complete removable dentures, the more your jawbone will shrink. Jawbone shrinkage occurs in areas where teeth are missing. And when all your teeth are missing, the entire surface of your jawbone shrinks. Your body takes the minerals from the bone and uses them elsewhere. As your jawbone shrinks, it’s more difficult for your denture to stay in place.

Dental Implants and Bone Volume

An implant dentist or oral surgeon places implants in your jawbone with the goal of the bone and implant fusing to anchor a denture or arch of teeth. If you have significant bone loss, your jawbone won’t support implants.

If You Don’t Have Enough Bone for Dental Implants

If you don’t have enough jawbone to support dental implants, implant dentists offer two treatment options—bone grafting and All-on-4 dental implants.

Bone grafting for dental implants

Bone grafting for dental implants is a procedure that takes bone from one part of your body, like your hip, to use it for building up your jawbone. As an alternative, a dentist might use sterilized or artificial bone. Depending on the type of bone used and the extent of bone loss, the Academy of Osseointegration says it can take four to twelve months for grafts to heal. After healing, you can receive dental implants. Your implant dentist will explain your options for grafting.

All-on-4 dental implants

Denture above dental implants ready to be screwed on

Dental implants secure dentures

All-on-4 dental implants are a system that angles implants in the front of your mouth. The bone in the front of your mouth is often thicker than other areas. And angling the implants increases contact with the bone and resistance to movement. Implant dentists use 3-D cone beam computed tomography (CBCT) scans to see your bone structure and identify a precise location for All-on-4 or All-on-6 dental implants. This process prevents the need for bone grafting. But your implant dentist will determine if you’re a candidate for this treatment.

For predictable results, look for an implant dentist who is a Fellow of the International Congress of Oral Implantologists. Dentists with fellowship have advanced dental implant training and experience and have completed rigorous testing and examination of their patient cases by a review board.

You can receive implant-supported dentures and have a comfortable, confident smile at last.

 

Steven Brooksher, DDS, a Baton Rouge dentist, sponsors this post. Dr. Brooksher is an accredited cosmetic dentist and a Fellow of the International Congress of Oral Implantology. He completes implant surgery and restores implants with dental crowns or dentures.