An alternative to root canal treatment 

Alternative to root canal

Root canal treatment is recommended to save permanent teeth. Patients often look for an alternative to a root canal treatment because of the anxiety, risk of failure, and increased cost associated with the treatment.

In this article, I will discuss the alternative options to root canal treatment. 

Why is a root canal done?

Root canal treatment is done to restore the function, appearance, and bite in a damaged tooth. It is the most effective way of saving a tooth. 

Root canal treatment is attempted when a tooth undergoes irreversible pulp damage due to a deep cavity, injury, crack, or fracture to the tooth.

The pulp is the deepest layer of the tooth, rich in blood vessels, nerves, fibers, and reparative cells.

Click on the link for full article on, How do you know if you need a root canal?

What are the alternatives to a root canal treatment 

Pulpotomy 

Pulpotomy can be done to treat deep cavities in adult teeth as an alternative to root canal treatment. 

Steps of pulpotomy in permanent teeth

The pulpotomy involves the removal of the coronal pulp (pulp in the crown part of the tooth above the gums), leaving the root pulp. A medicated dressing is placed on the root pulp, and the tooth is closed with a temporary filling. 

You will be recalled for follow-up visits to see if the treatment has healed the root pulp. The signs of severe pain or swelling in the tooth following the therapy implies that the tooth requires complete removal of the root pulp (aka root canal treatment).

Patients who can get a pulpotomy treatment

A pulpotomy cannot be performed on every tooth. It is performed in patients who fit the following criteria:

In these patients, we know the bacteria have invaded the pulp but don’t know the extent of irreversible pulp damage inside the tooth as the tooth surrounding area is healthy. Therefore, a pulpotomy can be attempted. If the tooth shows no signs of pain or swelling, a permanent filling can be placed later. 

Moreover, bleeding lasting more than a few minutes after the pulp removal shows that the root pulp has gone through irreversible damage and requires a root canal treatment.

Click on the link for full article on, What is a pulpotomy?

Extraction of the tooth – The most common alternative to root canal treatment 

Tooth extraction is an alternative to root canal treatment. In modern dentistry, tooth extraction is the last option to remove the infection when a tooth can’t be saved with other therapies.  It has opted for patients who can not afford root canal treatment and is frequently done in developing countries. 

Tooth extraction has been practiced for centuries. Before the discovery of antibiotics, it was the most preferred treatment method.  

Tooth extraction procedure

A local anesthetic injection is given to numb the tooth and surrounding structures. Tooth extraction involves loosening the tooth with elevators to separate it from the bone, followed by removal with forceps. 

Forceps are designed according to the shape of the individual tooth to hold it tightly and facilitate its removal without breaking the root, crown, or bone.

After extraction, a wet gauze is placed on the socket to stop the bleeding. The socket takes 7-10 days for soft tissue healing. Bone filling and socket obliteration take 6-12 months. 

Click on the link for full article on, How long does local anesthesia last?

Pros of tooth extraction

The following are the benefits of extraction:

  • It is relatively cheap 
  • It requires less time to remove a tooth.  
  • You can get an implant after extraction, which is as strong as a tooth. However, it is expensive.

Cons of tooth extraction 

The following are the disadvantages of tooth extraction: 

  • If the extracted tooth is not replaced with an implant or denture, it will affect your appearance if it’s a front tooth  
  • The adjacent teeth may tilt or move into the space and can cause bite problems 
  • Molar extraction can make your eating difficult.
  • You have to spend more money if you want a replacement. A dental implant is the best option after tooth extraction. However, it’s best to retain a natural tooth. 
  • Teeth maintain bone height. When a tooth is removed, the bone in the area of extracted tooth shrinks in height and width, which can affect your smile.

Tooth replacement options after tooth extraction 

There are three options to replace extracted teeth 

  • Partial dentures 
  • Bridge 
  • Implants 

Removable partial dentures are the most affordable method to replace missing teeth. However, due to their acrylic plate and wire, they may be uncomfortable for the patient. 

The bridge is a fixed prosthesis and requires the cutting of adjacent healthy teeth to hold the prosthesis in place. They cost you more than a removable partial denture.

Dental implants are the best way to replace extracted teeth. They mimic teeth in how they are anchored to the bone with a screw similar to the tooth’s root. Implants require three months for the fusion (osteointegration) of the screw to the bone before prosthesis placement. Nowadays, immediate implants are also available that are loaded after the insertion, but they require healed socket. 

Apicectomy (apical root surgery)

It is not an alternative approach to root canal failure. It is attempted in teeth with root canal treatment, where the inflammation around the tooth hasn’t healed.  

The X-rays show a well-performed root canal with no voids or missed channels, but exhibits persistent inflammation around the tooth’s root. Therefore, rather than removing the crown and doing the whole root canal again, the dentist may opt for apical root surgery, known as apicectomy. 

During apicectomy, after numbing the area with a local anesthetic injection, a cut is made on the soft tissues, and a flap is raised. The bone is removed with a dental drill to expose the root, and the diseased tissue is removed. The root end is resected (removed), and a small concavity is made. This cavity is filled with the filling to seal the tooth. 

Why should you consider getting a root canal when your dentist recommends it?

Root canal treatment saves your teeth by removing all the infection that has caused tooth destruction. The crown placed after the root canal strengthens the weakened tooth structure. Thus, a root canal treatment followed by a crown restores the tooth function, speech, and appearance of the tooth.

It is a safe procedure lasting 15-20 years and even longer. If you opt for an extraction, you have to go for tooth replacement, which will cost you additional money. 

Discuss your concerns with your dentist. Procedural anxieties, such as fear of pain, local anesthesia, or tooth drilling, can be managed. 

If you can’t afford the treatment, talk with your dentist. Some dental offices provide treatment and let you pay the cost in installments. Moreover, if you can afford private health insurance, get dental insurance in advance that covers major dental procedures. 

If the risk of root canal failure is bothering you, speak to your dentist. Root canal failure often occurs in severely broken teeth and teeth with severe infection at the time of treatment. 

Click the link for full article on, How long does a root canal take?

Latest advances in root canal treatment

Root canal treatment has evolved with better materials, a dental operating microscope (for canal location), and engine-driven instruments (for canal preparation and disinfection). These technologies have increased the success rate and reduced the treatment time of root canal treatment. 

A lot of attention has also been given to canal disinfection methods which is the primary aim of root canal therapy. The latest technologies used for canal disinfection propel the disinfectant fluid into the nooks and crannies of the complex root canal system where traditional disinfectant solutions cannot reach

Some of the new methods of canal disinfection are:

Conclusion 

Root canal treatment is required when your tooth goes through irreversible changes and can’t be saved. People look for other alternatives to root canal therapy because of the procedural anxiety and increased cost of treatment. 

Pulpotomy can be done in young patients and can’t be attempted in every patient. Extraction is the most common alternative suggested to patients unwilling to take root canal treatment. 

An apicoectomy is a surgical procedure done on failed root canal cases where the tooth is accessed from the root end.

Root canal treatment has constantly been evolving with the discovery of better disinfectant methods and the use of dental operating microscopes etc., with more success rates and reduced treatment time. 

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