The Decision on Dental Implants
Dental implants are far and away the most predictable and successful method of replacing missing teeth. But are dental implants always the right decision? The answer of course is no.
In evaluating your mouth, diagnosis and treatment planning come first, the implements of that treatment are second.
Let me tell you a story. A patient comes in. She has a badly decayed lower molar. To save the tooth would require a root canal, removal of the decay and placement of a supporting element called a core, doing a crown lengthening procedure which involves removing enough of the gum and bone around the tooth to expose healthy tooth structure that can be crowned, and then doing the crown itself. That’s a lot of work and still the tooth itself is a relatively weak tooth. In other words, there is so much natural tooth structure gone, that even in the best of circumstances, the remaining tooth structure is weakened by the decay. Therefore, doing all of those procedures to save a badly broken down tooth may result in a failure some time down the road.
The other alternative is a dental implant. The dental implant doesn’t decay. And we don’t have to do all of the procedures above to get to a result. Most importantly, the result is more stable.
Now should a dental implant be done every single time? No. The dental implant should be done when the tooth structure is so weak that its long-term stability is compromised. That is a judgment call and such a judgment call is the most important. Before a decision is made to do a root canal on a tooth, the first decision that should be made is whether the tooth is predictably restorable. If it is, then a root canal might be the right way to go. By the way, I almost always recommend that an endodontist do the root canal. Endodontists are specialists, do root canals every day, and I believe give you a much better chance of success.
If the tooth is not predictably restorable, then an extraction and an implant is the better choice.
A periodontist is the specialist that would provide you with a good opinion on the above. You can see a periodontist without being referred to one. Or if you want a second opinion, ask your dentist to refer you.