Failed Root Canals
Definitive Retreatment Choice
Root Canal procedures can fail for several reasons. For molar tooth locations, the high probability of having branched or convoluted roots, which often can't be seen or detected via xrays, increases the chance for eventual failure.
|Two Failed RCT's
In the adjacent picture it can be seen that one tooth broke at the gum line while the other, adjacent root canaled tooth showed signs of failure and was impacting the surrounding soft tissues.
The second photo in this treatment series shows several chunks of damaged teeth and also provides evidence of two broken root canal files in the same root (of the broken tooth).
Files rarely break due to dentist error.... rather, it is a reflection of the physical characteristics of the tooth root(s). In this case, many dentists or specialists would have curtailed treatment and recommend an extraction with dental implant replacement.
|Damaged Teeth Extractions
Unfortunately, despite the advances in digital radiography (2D and 3D xrays), many tooth structures cannot be diagnosed at the 100% level. Branched and convoluted roots don't "show" well.
As a result, some patients may have a root canal treatment that is not 100% successful in eliminating the perception of pain, discomfort and in some cases, repeated infections.
|Xray Evidence of Potential RCT Failure
This event is often attributable to "unseen tissue conditions".
Endodontists, who specialize in Root Canal Therapy, despite having high power magnification and microscopy, also experience these types of treatment failures.
Missed Red Flag(s): Beginning of the End?
The 2D xray provided here provides overwhelming evidence that one tooth has shifted and slanted.
Because successful root canals cause an immediate obstruction or obliteration of the normal nutrient supply to the remaining tooth structure (which is why immediate crown restorations are always recommended), the slanted tooth structure was doomed to fail. Not "if".... only "when"....
The broken files should have provided additional "signals" that the RCT would be at risk for failure. The ensuing inflammation and infection eventually affected the adjacent tooth that was also treated.
|Reconstructive Bone Grafts
The only sensible retreatment for the two failed root canals that probably should have been recommended from the very beginning is extraction and dental implant replacements.
Dental implants thrive in high bite pressure environments (molar areas) when supported by substantial, healthy bone.
The extraction sites for this patient were treated with bone graft material to specifically correct lost height and width. The sites were allowed to completely heal (average is 3-4 months). See photo of newly healed bony ridge.
Once healed, the newly fortified ridge of bone was prepared, via implant surgery, for two (2) select precision implants that were correspondingly sized for the patient's bone characteristics.
|Placement of Implants
Temporary Implant Crowns
Acrylic temporary crowns were used to assure ample time for making final adjustments for fit, feel and adapting to the patient's occlusal plane.
Since the new tooth structures couldn't be seen in the patient's customary smile, color shading was not critical.
|Completion of Implant Restorations
New Porcelain Teeth
After a few weeks, when all technical considerations (from the dentist's perspective) are satisfied and the patient confirms the return of normal dental function, the temporary crowns are used as models or templates for the new porcelain restorations.
Material provided by:
Ara Nazarian, D.D.S.
Michigan Reconstructive Implant Dentistry
1857 East Big Beaver Road
Troy, Michigan MI 48083
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