Do I Need Root Canal or an Extraction and Implant?

Three years ago, my wife and I got in an accident that released the airbags in our van. I took a hard blow to my face, and since that time, my front left tooth has been sensitive on and off. My dentist said she would watch the tooth, but it began to turn dark last fall.

I saw my dentist last week for the first time since Covid, and she referred me to an endodontist for a root canal. The endodontist will complete the root canal next week. Will the root canal improve the tooth color, or will I need to see a cosmetic dentist? If I need a root canal and a cosmetic dentist, who will probably recommend a porcelain veneer? Should I get an extraction and dental implant anyway? – Thank you. Gordon from Tampa, FL

Gordon,

Thank you for your question.

Will Root Canal Treatment Lighten a Dark Tooth?

Root canal treatment will not lighten a dark tooth. It often makes a tooth darker. Why would root canal treatment darken a tooth? When a dentist leaves root canal filling material and cement in the portion of the tooth above the gumline, the tooth darkens.

Preventing a Tooth from Darkening After Root Canal Treatment

Your dentist can minimize the darkening effects of root canal treatment with these steps:

  • Remove root canal filling and cement from the tooth crown
  • Bleach the tooth internally
  • Seal the bleaching solution inside the tooth
  • Insert a flexible fiberglass post in the tooth and fill the tooth with composite, or correct the color with a porcelain veneer

When you have most of the structure left on a front tooth, preparing it for a crown can weaken it and increase the risk of it breaking. A cosmetic dentist can correct the color with a porcelain veneer after root canal treatment if your front tooth is intact.

illustration of a dental implant in three stages
Saving your tooth with root canal treatment is better than a dental implant

Unless your tooth is severely damaged and the endodontist (a root canal specialist) cannot save it, it is best to preserve it and avoid extraction and a dental implant. We recommend scheduling a second opinion with an advanced cosmetic dentist to examine your tooth and discuss your treatment options.

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Could I Get Dental Implants and Not Dentures?

I have advanced periodontal disease and have lost seven teeth as a result. My dentist is starting to suggest dentures but I want to know if I can get dental implants instead?

Avery

Dear Avery,

illustration of a dental implant in three stages

Dental implants are always the best option in tooth replacements. In most cases, if you are in good general health you will be a candidate for dental implants. Your case is a little more complicated with your gum disease, so you will need one extra procedure.

As you can see from the image above, it is important that there is enough bone structure there for the dental implants to integrate with. This is what helps keep them stable and attached to your jawbone. Your periodontal disease has led to a loss of that bone, which is why your teeth are falling out. In order to have a successful outcome with your dental implants you will want to get your gum disease under control and then have some bone grafting to build back up the missing tooth structure.

As tooth replacement options go, dental implants are far superior to dentures. Even the best fitting dentures reduce your chewing capacity by 50%. On top of that, when your teeth are removed your body recognizes that and begins to resorb the minerals in your jawbone to use elsewhere in your body. After ten years or so, you will no longer have enough jawbone to even retain your dentures. This is known in dental circles as facial collapse.

Implant Overdentures

Implant Overdentures
Implant Overdentures

It is way too expensive to do a one-to-one ratio of teeth to dental implant when you are talking about replacing all of your teeth. In those cases, implant overdentures are recommended. This uses between four to eight dental implants on each arch, depending on your budget, and then anchors a pair of dentures to them. This still gives you all the advantages, protection, and security of dental implants, at a fraction of the cost.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Cosmetic Bonding Gone Wrong

I had four of my front teeth “repaired” with dental bonding. The front two teeth overlapped a little and the other two teeth he did to make sure everything matched. Here are my problems. First, he ground down the two teeth quite a bit and added a bunch of bonding, but the backs where he ground feel sharp and painful. Second, he used a yellow color even though I told him I wanted white. When I complained he said it was the only way to get all my teeth to match. I feel like my smile was prettier before he did this work. Can this be made to look good?

Amelia

Dear Amelia,

Before and After Dental Bonding-

This can be made to look good, but I’m not certain that your dentist has the skills to make that happen. The fact that he needed to add bonding to extra teeth that didn’t “require” it in order to get the color to match, is one hint that he is in over his head. If you look at the image above, you can see that dental bonding is able to match a tooth even when doing small areas. In fact, that is what dental bonding is intended for–small repairs, such as chipped teeth or small tooth gaps.

I’m not quite sure I understand what you mean by the backs feeling sharp and painful. As you have to get this redone to look the way it should, the new dentist should be able to repair whatever you mean by that. Your dental work should never be painful.

As to the color. Why didn’t he just have you whiten your teeth with professional teeth whitening if you wanted white bonding but the adjacent teeth were more yellow? It is common to whiten teeth before any type of cosmetic work because most people want their teeth white when they get any type of smile makeover done.

Finding an Excellent Cosmetic Dentist

Cosmetic dentistry is not a recognized specialty therefore any general dentist can technically call themselves a cosmetic dentist. To make matters even worse, smile makeovers are not taught in dental school. It is completely up to the dentist how much, if any, training he gets in doing cosmetic work.

Because of this issue, the American Academy of Cosmetic Dentistry (AACD) began an accreditation program to help dentists get the training they need and patients to know who has the expertise necessary. The best cosmetic dentists in the country are AACD accredited. I’d start there.

Dental Bonding or Porcelain Veneers

porcelain veneer being placed on a tooth
Porcelain veneer

As I mentioned earlier, dental bonding is meant for small repairs, like chips and gaps. It is not really as useful over large surfaces. Plus, it only lasts a few years. It’s one thing to replace a tiny section every few years, but whole surfaces of teeth will get very expensive quickly.

Because of that, don’t be surprised if whatever dentist you see suggests porcelain veneers to you. These are tiny wafers of porcelain that can be bonded to your teeth. They are more stain-resistant than dental bonding. In fact, they are even more stain-resistant than your natural teeth. When done well and cared for, they can last your lifetime.

This blog is brought to you by Salem, MA Dentist Dr. Randal Burba.