So are Biological dentists dead against keeping root canal treated teeth?

The answer is that we can only present the concerns covered in the Root canal page, around root canals to patients but the decision as to what to do, needs to be made by the individual, taking their current systemic health into account; the number of root canal treated teeth present in their mouths; the presence of osteonecrotic areas in their jaws; the presence of mercury fillings – including the duration of time they have been all present and most importantly, where the root canals are in the mouth. This latter point, is often where biological dentists will draw the line: anterior teeth and to a lesser degree, premolars have a less complicated pulpal network and tooth structure, so considering apexification as a solution, provides an alternative option where patients don’t want to lose a front tooth or a canine. This requires long term commitment from the patient and dentist for the many visits which will be required for the surrounding apical bone to regrow before the tooth is sealed.

Where the patient has an infection in a molar and or they are dealing with a chronic condition with their health, the removal of a dead and infected tooth may sound extreme, but in light of the havoc oral pathogens can cause, it is often the lesser of two evils especially when considering the implications of root canals for long-term health.

Once the tooth is extracted, the surgical area will be widely debrided and grafted with PRF, which will allow the for the tooth to be replaced with a metal-free zirconia dental implant.

However, some patients prefer not to place an implant, in these instances, alternative options include:  a Maryland bridge (where an anterior tooth has been removed and is clear of the bite), cantilever or pontic zirconia bridge, a removable partial or even a “remove the tooth and do nothing” approach. 

The important thing is to understand the risks and benefits of any dental procedure and determine the option that best matches their needs, goals, finances and values:

• Replacement with a zirconia implant 
  • The implant is placed minimum 3-6 months after the tooth removal to allow for the bone to grow back so ensuring integration of the implant in healthy bone
  • This is a highly biocompatible option
  • Long term success and highly aesthetic with a zirconia crown, 3-6 months later when there is solid bone integration
  • But this does not provide an immediate solution
  • Considered costly by many patients but long term this is a more viable solution
• Replacement with
  • Maryland Bridge – semi-permanent option (3-5 years)for anterior teeth but has a metal winged mesh for attachment to adjacent teeth and the gum around the tooth may pull away leaving a gap which is not ideal aesthetically. But this can offer an immediate solution for anterior single tooth loss at a relatively “cheap” fee.
  • Traditional Zirconia Bridge – permanent, metal-free, and biocompatible – longevity is medium to long term (7-15 years). This is a better option where bone loss is extensive or in the case of maxillary jaw where the sinus drops down or would be compromised if an implant was placed.
  • Removable prosthetic appliance – removable, metal-free or with stainless steel clasps. It offers an immediate tooth replacement option, especially where multiple teeth are missing/have been removed. Most cost effective option but if placed as an immediate solution, it will require relining and replacement as bone shrinks away as it heals and over time. Thus longevity is short to medium term (3-5 years)
• Do nothing at all, leave extraction area with no replacement 
  • Compromised function, especially where multiple teeth are missing
  • A consequence of tooth shifting and bite changing and TMJ issues down the road
  • Side effects of sinus dropping for maxillary teeth
  • Facial changes and facial droop (depending on the location of the extracted teeth)

How Does a Biological Holistic Dentist Diagnose an Abnormal or Infected Root Canal?

Root canals are diagnosed most accurately using a 3D CBCT Scan. Many dentists and specialists may have a cbct scanner, but very few are radiologically trained to properly interpret or read a 3D scan. Understanding the extent and implications of a periapical area, its impact on the surrounding bone and tissues, and its link to the systemic health of the patient, lie in years of experience aa an trained and accredited biological dentist who has surgically seen what this area looks like and witnessed the consequence on patient health. Statistics show that less than 10% of dentists have 3D CBCT scan machines, and of those, less than 10% of them actually scan patients for any other reasons other than planned surgery or procedure planning based on an existing diagnosis such as wisdom teeth or implant placement planning. Thus, 90% of root canal infections go undiagnosed by conventional dentists and non-3D CBCT radiology-savvy dentists

Periapical Xrays which show the root of the tooth, are a great adjunct, especially with primary clinical consultation,  but only in 2D (flat image file) and unless the root canal infection has been festering for an extended period of time, is massively large and has significant bone loss around it, the root canal infection will still likely be under diagnosed by the dentist. Thus, the additional use of a 3D cbct scan is critical in providing the dentist and the patient with all the information they need, to make an informed decision around the infected tooth.