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Treatment provided by Dr Andrew Nixon (implant-restorative-dentist) and Dr Paul Coceancig (oral & maxillofacial surgeon).
This 23 year old lady had a darkening upper left central incisor tooth, and a recommendation for an apicectomy.
Root canal treatment had failed to control a growing peri-apical abscess, and the tooth crown had significantly darkened.
The patient sought treatment options, specifically to compare apicectomy & crown, vs extraction & implant replacement.
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Photo shows darkening left maxillary central incisor, following a knock & then root canal therapy. Notice the darkening of the tooth, which remains tender to slight percussion, and when palpating directly over the apex of the tooth. |
Normally when a tooth is knocked, the nerve & blood vessels inside the tooth pulp dies. Stagnant blood cells become absorbed into the white enamel crown, and the tooth crown slowly darkens (see haemosiderin stain).
Close up x-ray view of central incisor , showing a dark area at the apex of the root canal filled tooth root.The white substance is gutta percha. |
A root canal filling involves cutting a small hole on the backside of the tooth, & which then allows for cleaning and preparing of the nerve (pulp) chamber, & filling with gutta percha. If the root canal therapy is successful, then a porcelain cap is cemented over the prepared crown, and a central post is placed down the centre of the now brittle tooth.
If there is evidence of disease at the very apex of the tooth, then a recommendation is often made for a repeat root canal filling, usually with a specialist endodontist. If this repeat therapy fails, then a surgical apicectomy is recommended.
Apicectomies have ~50-60% success rate, but requires formal specialist surgery, and a period of time before surgical success is confirmed.
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The other treatment option was to remove the tooth, and provide immediate replacement by a dental implant.
So to compare both treatment options...
Ongoing root canal therapy vs Extraction & implant replacement
Repeat the root canal therapy with a specialist endodontist. Estimated treatment time about 3 months, and cost ~$2,000. Chance of success... 50%
If the root canal therapy does not work, then an apicectomy. Another operation, this time in a hospital with an oral surgeon, and cost ~$1,000 (plus hospital and anaesthetist fees). Treatment success... 50%
If the apicectomy works, then a post, core and crown to strengthen the tooth, and lighten it... Cost $2,000. Treatment success over 5 years... ~50%.
Total costs, $4-5,000 and chance of success... 50% x 50% x 50%.
If this fails (>75% chance), then proceed to implant replacement (see right). |
Immediately remove the tooth, and replace with a titanium implant provided by a specialist surgeon... Cost ~$3,000. Chance of success... ~100%.
Visit to Implant restorative dentist occurs three months later, & he places an ideal & perfect implant supported zirconia crown... Cost ~$3,000. Chance of success... ~100%
Total costs ~$6,000.
Treatment time 3 months.
Chance of success ~100%.
Longevity... forever |
Not surprisingly, the patient elected for option 2.
After surgery photo showing removed tooth, and replaced with healing abutment for precise gum molding. |
The first appointment was to remove the tooth, and painlessly replace it with a titanium implant & healing abutment.
The process took about 30 minutes, and occurs with a local anaesthetic under sterile operating conditions.
Of course the patient can also elect for IV sedation or full general anaesthesia.
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PA radiograph left central incisor. Titanium implant shown with normally osseointegrated surrounding bone. Zirconia abutment with porcelain crown is attached to the underlying titanium platform. |
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Final clinical photo. Beautiful enamel hues and blends, coordinated with an anatomically perfect crown. Crown placement and color matching courtesy of Dr Andrew Nixon, Implant Restorative Dentist, Newcastle.
Careful flossing, and yearly check ups with the restorative dentist should ensure lifetime, trouble-free function form the crown, with maintenance of periodontal health in adjacent teeth. |
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