tooth extraction Archives - Atlanta Dental Implants

Can I Skip a Repeat Root Canal and Get an Implant?

Posted on April 22, 2025 by AllSmiles.

I had a root canal on an upper right first molar in 2020. I’ve had no problems with it until this year. Now the tooth hurts daily. My dentist wants to repeat the root canal. I would rather have a dental implant than another root canal. The root canal wasn’t painful, but my recovery was. Finally, the tooth settled down. How can I convince my dentist to refer me to a perio for an implant? Thanks. Trevor from TN

Trevor,

Your discomfort suggests the tooth didn’t fully heal after the initial procedure, leading to a recurrence or flare-up of the underlying infection.

Understanding Why Root Canal Treatment Might Need Revisiting

Root canal therapy is a meticulous process to clear infection from the intricate network within a tooth’s root. However, achieving complete, long-term success can sometimes be challenging due to the complex anatomy of teeth. If any infected nerve tissue (pulp) remains in hidden canals during the first procedure, complications can arise later.

According to dental research, including findings published in the Journal of the American Dental Association, several factors can contribute to the need for further treatment after an initial root canal. These challenges highlight the technical complexities involved in treating the inner structures of a tooth:

Incomplete cleaning or shaping of the canal system, leaving infected tissue behind.
Difficult-to-detect accessory or curved canals can make infection removal challenging.
Issues with the final filling material include under-filling or over-filling the canals.
Accidental perforations (small holes) in the root structure can cause complications.
In rare instances, a tiny dental instrument’s separation (breaking) within the canal.

While root canal treatment is highly successful overall, failure does occur in approximately 10% of cases. If the tooth doesn’t heal completely, an infection might remain dormant for months or years before becoming noticeable. Lingering infection occurs when dentists encounter canals that are difficult to see or navigate fully, especially deep within the root or with significant curves. Addressing these challenging cases may require advanced training and specialized instruments used by endodontists (root canal specialists) or dentists pursuing extensive post-graduate training in endodontics.

Treatment Options for Root Canal Failure

A dental implant with components labeled - crown, abutment, implant screw

Schedule a consultation with a periodontist for dental implant placement

Effective options are available when a previous root canal treatment hasn’t fully resolved the issue. The standard approaches are repeating the root canal treatment (retreatment) or performing minor root canal surgery (an apicoectomy). If your current dentist doesn’t have specialized training in complex root canal procedures, they will refer you to an endodontist for evaluation and care.

During retreatment, the endodontist will:

Carefully re-access the inside of the tooth.
Work to identify and locate the source of the persistent infection.
Thoroughly clean and disinfect the root canal system again.
Refill and seal the canals properly.

Alternatively, during an apicoectomy, the specialist accesses the tip of the tooth’s root directly through the gum tissue and bone, allowing them to treat the infection from the end of the root rather than through the crown.

We encourage you to schedule an appointment promptly for an evaluation. After a thorough examination and review of X-rays, an endodontist or a dentist skilled in advanced root canal therapy can assess whether your tooth is savable. Your dentist’s priority is to preserve your natural teeth if possible. Otherwise, your dentist may refer you to a periodontist for a dental implant.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

Must Half-Broken Front Teeth Be Extracted?

Posted on June 26, 2024 by AllSmiles.

Must halfway broken front teeth be extracted? The tooth roots are still there. Will a root canal and caps work, or will I need extractions? I hope you get this message. I’m trying to get a dental appointment today. Jehu

Jehu,

A dental implant is the best way to replace an unsavable tooth. Consult a periodontist.

We understand your concerns and hope you were able to see a dentist promptly. Immediate care increases the chances of saving a half-broken tooth.

Must Half-Broken Front Teeth Be Extracted?

Half-broken teeth don’t always require extraction. A dentist may be able to save the tooth with root canal treatment, a dental post, and a crown (cap). Whether a dentist can save a tooth depends on the extent of damage, the patient’s bite, and the dentist’s attitude about saving a tooth with a severe break.

Rotational force on a tooth can loosen a tooth post, so skilled dentists may use two posts in the root to help the tooth withstand biting forces. A rigid post can break the tooth because the rigidity will transfer into the tooth and crack its root. Therefore, a dentist must choose a carbon fiber, fiberglass post, or similar material—flexible for biting and the functions of front teeth. It’s important to be aware of these possibilities.

We recommend consulting a dentist skilled in root canal therapy or an endodontist (root canal specialist) to determine whether your tooth is savable. Otherwise, it may require extraction and a dental implant. See a periodontist (dental implant specialist) for expert implant placement and bone grafting if your tooth is unsavable.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Does He Need His Tooth Extracted?

Posted on September 1, 2021 by writeradmin.

I had a problem with a tooth hurting and it has a little white bubble on it. My dentist wants to extract the tooth and put a false one there. I’m only 20. Is it normal to lose a tooth at that age? I don’t know much about this because I’ve only had like one cavity in my life so this seems weird. What do I do?

Cameron

Dear Cameron,

That white bubble is probably an abscessed tooth. That means your tooth is infected. An infected tooth doesn’t necessarily mean that the tooth needs to be extracted. Often, an infected tooth can be saved with a root canal treatment and dental crown. Some dentists are better than others at trying to save teeth. Extracting a tooth is easy for them; saving one is hard work.

Because of that, I would like you to get a second opinion before moving forward with your dentist’s recommendation. When you do, don’t tell them who your dentist is or what your dentist diagnosed. Instead, just say you are wanting a blind unbiased opinion. My guess is he will tell you that a root canal treatment is really all you need.

However, if it turns out that you do need to have the tooth extracted, don’t panic. Having a false tooth these days is not at all like it used to be. Especially given your young age, I will recommend you get a dental implant. It’s a little more expensive, but it is the closest thing to having a healthy natural tooth in your mouth again. It’s completely secure and permanently placed. You won’t have to worry about anything falling out of your mouth.

I hope this helps.
This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

How Long Can I Wait to Get a Dental Implant?

Posted on May 30, 2020 by writeradmin.

I only recently got dental insurance. I’ve been going to the dentist anyway, but being cautious about what type of work I had done. Mostly I kept up with my checkups and cleanings. Quite a few years ago, a dentist put a crown on a tooth that needed a root canal treatment and put the crown on before doing the root canal. Because I wasn’t in pain anymore, he opted not to do the root canal through the crown. I’m wondering if that was a bad decision because the tooth under the crown has developed decay. The dentist doesn’t think he can get all the decay so he wants to pull the tooth then replace it with a dental bridge. I’m not crazy about either of those options. I’ve read that a dental implant is a much better option and I don’t really want to crown the other two teeth. I’m guessing my insurance will have a waiting period for either tooth replacement. How long is it safe to get a dental implant placed in the empty space?

Morgan

Dear Morgan,

I am seeing some real warning bells here about your dentist. At the risk of being too blunt, he is coming across to me as either lazy or incompetent. Neither one is a quality I want in a medical practitioner. Let’s start with this tooth extraction. While there are some teeth that can’t be saved, I’d like to at least see him try. He seems a bit too eager to me to just extract a tooth. I’d like you to get a second opinion with a periodontist before moving forward.

Second, you are correct about the right type of replacement as well. A dental implant is a far better tooth replacement than a dental bridge. Again, he is unnecessarily sacrificing tooth structure. Not okay.

As for the original, root canal, he should have done it even after he placed the crown. Many dentists have done root canal treatments trough dental crowns. Your dentist seems in the habit of taking the easy way out.

How Long Can You Wait Before Getting the Dental Implant?

Let’s say you have the worst-case scenario and your tooth cannot be saved. You don’t want to leave the empty space for more than a few days. The other teeth will start to drift and tip into the empty place. The good news is that won’t prevent you from waiting for your dental implant to be covered. Even a dental implant needs a healing period and time for the bone to integrate with the implant. Because of that, a dentist will put a temporary replacement like a dental flipper in there while the area heals.

Bottom line: Get a second opinion from a periodontist. If the tooth absolutely has to be extracted, you can have a flipper placed until your insurance coverage for a dental implant kicks in. I’d also start looking for a better dentist.

This blog is brought to you by Atlanta Periodontist Dr. David Pumphrey.

Top 3 Reasons to Consider Implant-Supported Dentures

Posted on December 15, 2017 by AllSmiles.

My dentist is suggesting that I have all my teeth removed to get dentures, and I’d be okay with this, except my dad really hates his dentures. He’s had them for about ten years, and they seem to get worse every year. I’ve heard about different types of dentures that go with dental implants, and I want to find out everything I can before I make a decision. Thanks for your help. Bob

Hi there Bob,

You’re right. There are a lot of different options for dentures these days, and it’s a great idea to educate yourself before you make an irreversible decision. There are a many different reasons to consider implant-supported dentures, but let’s focus on the three most important ones.

— Implant-supported dentures prevent bone loss, which can lead to facial collapse.
— Traditional dentures leave a lot to be desired, and they can make it harder to chew efficiently, fully enjoy the taste of your food, and enunciate clearly.
— Implant-supported dentures come in all shapes and sizes, so it’s not always necessary to remove all of one’s teeth to restore a healthy smile.

To begin with, the most important reason to consider implant-supported dentures is because when we lose a tooth, our body interprets the loss to mean that the bone in the jaw that supported that tooth can be used elsewhere in the body. So it begins to resorb those minerals, leading to bone loss. When we have lost most or all of our teeth, this bone loss can eventually lead to facial collapse, which is the shrunken appearance in the lower face we associate with extreme age. Implant-supported dentures prevent bone loss by acting just like our tooth roots do, signaling the body to maintain the jawbone.

Secondly, traditional dentures present problems that make it harder to chew and enjoy food and to enunciate clearly when speaking. This is because the top denture covers the entire palate and is held in place by suction, covering many taste buds and slurring our speech slightly. The lower denture is held in place with the tongue and cheeks, so slippage is a problem, leading to lower chewing efficiency. Typically, chewing efficiency drops by close to 50 percent with dentures, and this may be what your father hates so much about his dentures.

And finally, you can choose from a variety of different implant-supported dentures to best fit your particular situation.

- — Removable implant-supported full dentures are more secure than traditional removable dentures and address most of the problems we mentioned, including bone loss.
- — Fixed implant-supported dentures can feel more like a new set of permanent teeth.
- — Implant-supported partial dentures can replace two or more missing teeth.
- — And implant-secured bridges mimic your natural teeth with fixed porcelain crowns.

It would be a very good idea to question your dentist about why he or she wants to extract all of your teeth. It is always better to preserve as many teeth and as much natural tooth structure as possible. Don’t be afraid to ask a lot of questions and do more research to find a dentist who will provide the kind of care you really need.

Good luck to you in restoring a healthy smile.

This blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta.