Is This Tooth Worth Saving?by Dr. Richard Janis on 11/06/13
A common occurrence in my office is for someone to show up with a broken tooth. A question that I get asked a lot when a tooth breaks badly is, “Can this tooth be saved”? The answer is not always so simple. I have been doing this for over 20 years and my views have changed with the advent of predictable implant treatment. A better question is, “Is this tooth worth saving”? The answer is, “It depends”. Often, a tooth that is badly broken down can be saved with a root canal, crown build-up, and a crown. If the tooth has broken far below the gumline, then crown lengthening by a periodontist may also be needed to expose more tooth structure to support the crown.
However, another and often better option exists, and that is removal of the tooth and placement of an implant and crown. Of course, extraction and a bridge is also an option but for the purposes of this blog, I will discuss the best option, an implant and crown. A dental implant is a device made of titanium that is placed in the bone to replace the missing root. A crown is then placed on top of it. In the case where a tooth is badly broken down, this option will have a better prognosis. A root canal, build-up, and crown can be a good option and I have done many of them but I have also seen failures. Sometimes all of that is done and a few years down the road the patient comes in with a crown and tooth broken and not restorable. An extraction now has to be done and that, of course, is very frustrating and it has caused me to think long and hard about what is the best investment for my patient. So when is a tooth that is broken down worth saving? I believe if there is a good implant option, then a tooth is only worth saving if it has a better than fair prognosis. In other words, a good prognosis or better. How do I decide on the prognosis? Well, of course only time will tell if the decision was a good one but it is experience that allows me to decide.
I have been in my present office for almost 8 years and worked at the same place previously for over 15 years so that has given me the advantage of following-up and seeing what works and what doesn’t. A root canal, build-up and crown with periodontal surgery are sometimes what we might call “heroic measures” to save a tooth. Historically, that is what was done routinely, even if the prognosis was fair, because that was all we had other than extraction. Implants have brought a paradigm shift in dentistry and I rarely recommend heroic measures anymore. Dental implants are predictable and have a very good prognosis and that is why they are often the better option. Of course, there are exceptions, such as when the patient is unable to have an implant for medical reasons or if the tooth that breaks already has a root canal and the patient would be better served by just putting a crown on rather than having an extraction and an implant.
And what about the cost? A root canal, build-up of the tooth, and a crown can cost about 30% less than an extraction and an implant but if periodontal surgery is involved, the cost would be only 10-15% less. So cost is a consideration but I believe that the long-term prognosis should be the bigger consideration. An implant has a very good long-term prognosis. I am fond of saying that I have never had a patient regret the investment of having an implant done. I know that my patients are thinking of their improved quality of life and the long-term prognosis when they tell me that.