Category Archives: Dental Implants

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


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.

The Salem, Massachusetts dentists at Burba Dental Partners sponsor this post. Please read why our patients say we offer some of the best dental care in the Boston area.

Repeat Root Canal Failed But My Dentist Still Ordered a Crown

My dentist did a repeat root canal on a bottom left molar. After the root canal, an infection lingered for almost two months. An oral surgeon helped me get rid of the infection and said that my dentist should wait before putting a crown on. The tooth hurts again, so I think the infection returned, but my dentist already had the crown made without my permission.

I prefer an extraction and implant because the tooth is problematic and has interfered with my routine so much. Besides, if the tooth still hurts after a repeat root canal, I think putting a crown on it is a waste of money. Why would my dentist order a crown for a tooth that won’t heal? – Aspen from Illinois


You are correct. Your dentist should not have ordered the crown without your permission and without ensuring that your tooth healed. And you can refuse the crown because the tooth has not recovered.

When Should You Get a Crown on a Root Canal Tooth?

You can feel comfortable getting a crown on a root canal tooth when your dentist is sure that the treatment is successful. Preparing the tooth for a crown will further aggravate the tooth. And covering the tooth with a crown wastes your time and money.

Sometimes, root canal treatment can fail despite a dentist’s best efforts. But your dentist’s judgment was flawed in ordering a crown for a tooth that did not heal. Your dentist took a risk and is responsible for it. We recommend asking for a refund for lab fees or other fees that you paid toward the crown.

Should You Try to Save Your Tooth?

If your tooth is savable, perhaps a root canal specialist (endodontist) can save it. But as the number of root canal treatments increases, the likelihood of saving the tooth decreases. If you prefer an extraction, you can schedule an appointment for a second opinion from a cosmetic and implant dentist.

Diagram with five states of root canal treatment
Repeat root canal failure may require an extraction and dental implant

Burba Dental Partners of Salem, Massachusetts, sponsors this post. Read about what our dentists do to offer some of the best dental care in the Boston area.

How Long After Tooth Infection and Removal Before I Can Get an Implant?

How do I know that the infection is gone from a tooth that I had extracted? Is there a waiting period before I can receive a dental implant? I want to be sure that the infection is gone before putting an implant there to avoid having an infection with the implant. The dentist is ready to place the implant, but I just finished antibiotics. Is it safe to move forward? Thank you. Geoff from CT


When you have an infection in a tooth, other than a wisdom tooth, the tissue in the tooth dies. The infection exits through the bottom tip of the tooth root and goes into the bone.

Does Tooth Infection Remain After Extraction?

Extracting the tooth removes the source of the infection. Your body quickly eliminates the condition in the bone. Additionally, the extracted tooth leaves a drainage opening that inhibits the infection from lingering there.

Dental implant

It is rare to have a lingering infection after a basic extraction. Also, if you have finished antibiotics, your dentist prescribed them to ensure the infection is gone.

Infected wisdom teeth are different. In this case, the infection exists between the tooth and the gum. A dentist must remove both tissue and bone while removing an impacted wisdom tooth, and infection can spread to the surgical site. After the surgery, the wound is sutured closed. It is more likely to have an infection after the impacted wisdom tooth is removed, so dentists prescribe antibiotics to prevent it. But wisdom teeth do not get replaced with dental implants, so it is not an issue.

Although you are likely safe to get an implant, you can explain to your dentist that you want to wait a few weeks to ensure you have no symptoms. If your dentist is concerned about your comfort, they will wait.

Burba Dental Partners of Salem, Massachusetts, sponsors this post. We strive to offer some of the best dental care in the Boston area.

My dentist wants to remove my new implant

After three consultations with implant dentists, I chose the wrong one. After implant surgery, he told me that the bone was shallower than he thought. But he still placed the implants.

A month later, my dentist took an x-ray and said the implant was not healing correctly, so he wanted to remove it. He said that we could talk about other options, but a dental bridge is one of them.

The implant is not hurting, and I am very careful not to disturb it, so I asked my dentist for time to think about it. That was two weeks ago. I still do not know what to do, but I know that I want an implant. What are my options? – Thank you. Malcom from NJ


Thank your question. We are sorry to hear about your experience with your implant dentist. We are sure that it is frustrating. However, you can get the care you need.

If Your Dentist Places an Implant in Low Bone Volume

Illustration of a dental implant
A dental implant needs enough bone to fuse

If your dentist places an implant in low volume, it probably means that they did not take three-dimensional x-rays before your surgery. The x-rays would reveal that your bone is too shallow for implants and prevent healing. Still, your dentist should not have proceeded with the surgery.

Your dentist is responsible in several ways:

  • Breached the standard of care
  • Put you at risk for infection and trauma
  • Performed faulty surgery
  • Inconvenienced you because you must seek additional care

What to Do If Your Implant Failed Due to Dentist’s Negligence

If your dental implant failed due to your dentist’s negligence, you should demand a refund. If your dentist resists, you can do several things:

  • Report the issue to the state dental board
  • Hire a malpractice attorney
  • Get a second opinion from an advanced implant dentist and use the evaluation and proof of your dentist’s negligence.

Is It Too Late for a Dental Implant?

If your dental implant failed because your dentist placed it in low bone volume, it is not too late to replace it. However, a skilled implant will need to remove your loose implant, perform bone grafting surgery, and wait for three to four months for it to heal. Afterward, you can get an implant.

Best wishes for a smooth resolution.

Burba Dental Partners of Salem, MA, sponsors this post. Please read how our doctors strive to be among the best dentists in the Boston area.

Sinus Perforation During Dental Implant Procedure

I need to ask about something that happened with my dental implant procedure. First, some minor backstory. When my dental implant was placed the oral surgeon perforated the sinus by a few millimeters. He said this is fairly common. The problems started six months later when the gum would not heal and he suspected there was some bone loss. He removed the implant which went pretty smoothly because there was no bone integration with the implant. He stitched the gums and asked me to wait a year to see if the area fills back up. Here’s one thing I am frustrated with. He did not give me any antibiotics, just Flonase and some instructions on things like not blowing my nose for a while, etc. Five days later I went in for a follow up. I’d had pressure and felt yucky since the procedure. While he thought everything looked great, I didn’t feel that way and insisted he give me an antibiotic. He did and I started feeling better. Did he put me in danger by not prescribing one to begin with?


Illustration of a dental implant

First, I will answer your question, but there is a much bigger concern here that I want to address after. As to your question, no, he did not put you in danger by not prescribing antibiotics as a preventative measure. It is better for your body’s health in the long run if there is not already an infection, to try and allow the body’s natural defences to keep one away. It helps to strengthen your system. Having some medication jump in and do your body’s job when it doesn’t need help ends up weakening its ability to fight infection over the long haul. Think of it like a parent who always steps in to help their child climb the monkey bars by lifting them when it is hard. Sure, they get up the monkey bars, but it did nothing to develop their muscles. Waiting until your body needed the boost was the right course of action.

Two Problems with your Dental Implant Procedure

I see two really big problems with your situation. First, is the sinus perforation itself. Yes, it does happen. I certainly would not call it normal. Plus, the amount of the perforation is a big deal. A few millimeters is HUGE in dentistry. I am really concerned that he blew this off. This could only happen if he did not do adequate diagnostics. He should have done quite a few x-rays and preferable a CT scan also. The dental implant procedure is a 3-dimensional procedure and does require a 3-dimensional map.

The second real concern I have is that your bone never integrated with the dental implant. This leads to dental implant failure. This also indicates to me (again) that he may not have done adequate pre-surgery diagnostics. It’s possible you would have needed a bone grafting procedure to make this work.

My opinion– get a different dentist or surgeon to do this when you’re ready.

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

Replacing Baby Teeth with Dental implants

I am 16 years old and none of my canine teeth have come out. I had the bottom ones removed but the adult teeth behind them grew pretty far behind and it looks weird. I don’t want that to happen with my upper teeth. They show when I smile and that would be too embarrassing. I was thinking maybe I could remove those teeth and put dental implants in their place. Would that work?


Dear Avery,

I am impressed by how you are handling this. Though, I will admit I’m sad that you are having to do this on your own. Any decent pediatric dentist would have dealt with this years ago.

How you proceed with this will depend on what is actually going on with the adult teeth. If they are there but just impacted, then your dentist can do something to open the area. However, dental implants will not be an option. These only work to replace missing teeth. If you have teeth there, then you need a different solution.

If they are in a position where they’d come in crooked like the bottom teeth were then I suggest you see an orthodontist who can help them erupt properly.

If you have congenitally missing teeth, meaning that the baby teeth never came in, then dental implants are a possibility. However, you will want to wait until your jaw is completely developed in order for it to be a successful treatment.

That doesn’t mean you will have to go with baby teeth or missing teeth until then. You will need time to get the remainder of your teeth moved a bit anyway in order to make room for your replacement teeth. In that case, I would get something like Invisalign. Then, you can use a dental flipper to temporarily replace the missing teeth until your jaw is ready for the implants.

The best thing you can do is get to a dentist who can help you work through this.

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

Dental Implants and HOckey Players

My son is a hockey player. Most of his teammates have lost teeth but he’d been lucky up until last month when he had a tooth knocked out. We’d arranged for him to get a dental implant and have already had the implant placed. Now his teammates are telling him a dental implant is a bad idea in case he gets hit in the same place again. So, what should we do? I don’t want to leave him with a gap there.


Dear Elle,

hockey player with a tooth knocked out

That is interesting hearing what his teammates have said, but it makes sense. Your tooth has give. A dental implant is bonded. If the implant crown was knocked out, it would take some to the bone and possibly some jaw with it. That would require reconstructive surgery.

My suggestion is you leave that implant in. It will be good for his bone retention. However, you do not want to have the crown bonded on until he is done playing hockey.

Instead, I will suggest that he gets a temporary tooth replacement, such as a removable partial denture or a dental flipper. Either of these will give him a tooth while keeping him from damage to his jaw.

If he loses other teeth, I’d follow the same porcedure. Get the implant, use a temporary tooth replacement. Don’t just get the flipper without the implant.

When teeth are lost, your body recognizes that and in an effort to be as efficient as possible with its resources will begin to resorb the minerals in your jawbone in order to use them elsewhere in your body. This causes the jawbone to slowly shrink. People who wear dentures end up with facial collapse as a result.

Dental implants are how you prevent that. The implant serves as a prosthetic root and signals to your body that you have a tooth there and it leaves your bone intact.

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

Disastrous Dental Implant Case

I need some help. Close to three years ago, I had a full mouth reconstruction done that cost me $38,500. One by one, crowns and implants starting falling apart. I mostly have a mouth filled with implant screws sticking out of my mouth. I’ve contacted the office for a while and kept getting the run-around. Now I find out the dentist has fled the country and is currently in Egypt with no plans to come back. What do I do?


Dear Kelly,

Illustration of dnetal implants being placed in three stages.

This is a tough position to be in. If this dentist has fled the country, it is nearly impossible for you to get your money back. Instead, what you will need to focus on is finding a dentist who has the skills to fix these dental implants.

Just having dental school training is not enough. You really need someone with advanced post doctoral training.  For example, Dr. Burba completed Dawson Academy in Florida which teaches full mouth rehabilitation, complex restorative dentistry, and occlusion.

Before you see anyone, ask them what training they have in dental implants. Don’t just go based on fees. Cheap is not affordable. Cutting corners in dental implants tends to lead to disastrous failures in the case.

Which leads me to a second issue. Make sure your second dentist is very thorough with your diagnostics. I would insist on a CT scan. Dental implants are a 3-dimensional procedure and you really need 3-dimensional x-rays. Without them, your dentist could risk placing an implant on a nerve or perforating your sinus cavity.

Finally, check the online reviews. You want to make certain their follow-through matches their credentials and that patients have had a good experience with them.

Because you want someone with artistry as well as technical expertise in order to make sure they can create a gorgeous result, it will help if they are AACD accredited as well.

On that note, please leave a review both about the dentist who did this to you and then fled the country and the practice he was with that is refusing to refund your money. This will protect other potential patients from experiencing the same lack of adequate dental care you went through.

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

Dental Implants are Falling Out

I had dentures for a while and just really hated them. After doing some research, I decided to get implant overdentures, with eight implants total. This has cost me about $12,000. Yet, in less than a week three of them have fallen out and today a fourth one came out. Should I get a refund for those? Is there a way to get them back in? I really hated the removable dentures.


Dear Penny,

Implant overdentures

You should absolutely get your money back on those failed implants. To be honest, I wouldn’t have too much confidence in the ones that are left either. The current estimated failure rate for dental implants is 5%. Your dentist’s failure rate is 10 times that in just a week.

Most dental implant failures come from poor surgical placement. However, you mentioned you have been in dentures for a bit. You didn’t mention how long. When your teeth are removed, your body begins to resorb the minerals in your jawbone. It is possible, depending on how long you were in dentures that you did not have enough bone to retain the dental implants. That is something your dentist should have caught with his diagnostics.

My first recommendation to you is to see a dentist with real dental implant training, such as with Dawson Academy or the Las Vegas Institute of Advanced Dental Studies. Have them look at your implants and see if they can tell you what went wrong. If you had adequate bone support and it was a problem with the dentist’s surgical placement, then don’t just ask for a refund. Instead, ask for him to pay to have the new implants replaced by a dentist of your choosing.

This is because it will cost more to repair this than it did originally. Losing or removing dental implants takes bone with it. The missing bone structure will have to be replaced in order to have a succesful outcome the second time around. That can be done with bone grafting, but your dentist should cover that if you had enough bone to begin with.

If you didn’t have enough bone to begin with, then you would only need a refund. You would have needed bone grafting to begin with in that case.

You should not have any trouble getting a refund on this, especially if you have a second dentist advocating for you.

Best of luck. You can still get the implant overdentures you want!

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


I am trying to choose between Clear Choice Dental Implant Centers for all-on-4 dental implants or going to Costa Rica for traditional implants. A dentist here said I am not a candidate for the traditional implants because of my bone structure. Clear Choice said they can work around that, but I’ve heard Costa Rica will place implants when dentists here won’t. Do you have any experience with these scenarios?


Dear Ben,

Implant Overdentures

You are asking me to choose between the lesser of two evils. Here are my problems with both of those options. Let’s start with Clear Choice. They pretty much do the all-on-4 dental implant procedure for most patients. However, while the procedure can be useful in certain situations, it is also risky. If one part of it fails, the whole thing has to be completely re-done. A second issue with Clear Choice is there is no significant follow-up care. This puts you at risk of post-procedural complications.

One of the problems with the dental implant procedure is it isn’t adequately taught in dental school. Dentists have to take post-doctoral training in order to develop the skills necessary. Too many dentists are delving into this for the income stream, but without adequate training. It is one of the leading causes of malpractice cases at the time I write this post.

Now, take the worst dentist in the United States and you will still be better off than if you went to Costa Rica for this procedure. You say they are willing to do cases that dentists here will not. Of course they are! They don’t have to worry about your dental implant failure. You will be back in the States with zero recourse, and they will be raking in their profits. It is a no-lose proposition for them and a total gamble for you.

And what will you be gambling? Here are just some of the complications you could deal with.

  • You could lose a large portion of your jawbone, leaving you a dental cripple.
  • They could place the implant on a nerve, leaving you either in constant pain, no feeling at all, or even paralysis in the area.
  • They could perforate your sinus cavity.
  • Infection could set in.
  • The implants could be too short or too thin to retain properly.
  • They could be loaded prematurely leading to dental implant failure.
  • They could come loose.
  • You could end up with peri-implantitis.

Your safest option is to go to a solo practice here in the United States where there are standards of care and patient recourse if something were to go wrong. Look for a dentist with post-doctoral training.

I know your dentist said your bone structure would preclude you from receiving the implant procedure you want. However, with a bone grafting procedure, you will build back up the lost bone structure and can get the best replacement possible. Instead of an all-on-4, I would look at getting implant overdentures.

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