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Ask UsEndodontically-Treated Teeth Problem for Adjacent Implant?
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Dr. C. asks:
I know this is a highly controversial topic. I do all my own endo – I have a microscope – and I have just started placing dental implants. How much should I worry about an endo failing and contaminating an adjacent implant site? In the absence of gross signs – such as widened PDL, disrupted Lamina Dura, Radiolucent Lesion etc – is there any way to confidently determine that an endodontically treated tooth will definitely not be a problem for an adjacent implant?
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12 Responses to “ Endodontically-Treated Teeth Problem for Adjacent Implant? ”
Yes, you can say that “endo.treated tooth definitely will not create problem”,
IF YOU HAVE IN PAST AND EXPECT IN FUTURE 100% SUCCESS RATE OF YOUR ENDOS.
There may be some failures not just because of bad endo. but faulty restorastios,leaky posts,root fractures ect.
Best thing is to take care of failing endo at first discovery, if there is implant next to it.
I would respectfully disagree. If the implant is successfully integrated and an adjacent endo fails this usually has no affect on the implant. However, if the endo is failing but without signs or symptoms and an adjacent implant is now placed there is a stronger chance of failure. Any root canal that is over 10 years old I always view as suspicious. I have seen many root canals last 30 years but I have seen many fail at five years. The main reason I see for failure is root cracking both vertically or horizontally. I no longer reccommend molar endo especially in younger adults. The life expectancy of the implant is better. Plus Tarnow’s data indicates the obvious a crown on an implant lasts longer than on a rct tooth. Crowns on rct teeth can decay implant crowns cannot. There will always be a need for endo but I think the range for treatment is not as wide as it formerly was.
In my experience, a failing endodontically treated tooth, or a tooth in need of endodontic treatment, will “seek out” a newly placed adjacent implant that has not yet osseointegrated and cause it to fail. An osseointegrated implant is a lot less susceptible to failure by a similarly endodontically involved tooth. In either case, endodontically involved teeth, especially adjacent to implants need to be treated as soon as they are discovered.
Just another reason to do a preoperative CBCT to better evaluate the true endodontic status of the adjacent tooth. It is amazing how many RCT teeth have an unsuspect 2D radiographic picture and yet show up of 3D images with peri-apical and/or inte-radicular pathology.
How long would you wait to place an implant following root canal therapy on an adjacent tooth that had pulpal necrosis with a periapical lesion?
The question raise the problem of bacterial presence in endodontic lesions. Apical lesions are inflammatory lesions and do not necessary have bacterias inside. Sometimes, bacterias may go outside the endodontic canal but it is probably not the rule.
In case of radiographic image of an endo lesion on a teeth adjacent to an implant, just redo the endodontic treatment ! Or make a endodontic surgery with your microscope !
But please, make endo treatments on molars, especially on young adults, implant ARE NOT like diamonds: for ever.
Literature clearly shows that survival rate of single tooth implant IS NOT SUPERIOR to endo treated teeth.
(I have a pratice limited to Perio and Implants)
Patient had draining fistula at initial appt. PA film revealed lesion about 4 mm x 4mm. I performed endodontic therapy on the premolar in 2 visits using calcium hydroxide as the intracanal medicament. Fistula was no longer present at rct completion appointment. How long would you recommend the periodontist wait prior to placing an implant in the adjacent tooth site. Thanks, Tom.
THe only way to achieve relative safety for an implant in proximity to an endo tooth is to place it as far away from it as possible. No science behind this, but I would recomment at least 3 mm away from adjacent endo teeth and that close only if yous see a perfectly clean lamina dura around the endo tooth. The literature confirms that an endodontically treated tooth always has some lack of fill and some degree of low grade infection unless the canals are fileed by GOD himself. If there is any suspicion whatsoever that the endo may have a little leak - watch out! I have several cases wherre I am doing apicos on implants that were placed in areas of previously endodontic chronic failures and the bugs have made a comeback. Never underestimate the potency of a chronic endo lesion. You’ll get away with it most of the time, but it hurts when you have the failures due to the endo. Proceed with caution
Unfortunately there is no way to determine if an endo problem will affect an implant placed in the close proximity of the tooth. As Marc Quirynen showed us during a close meeting of the Italian Society of Osseointegrated Implantology, there is no radiographical difference (on a periapical film ) between a sound endo treated tooth apex, and one with a 2×2mm and 5×5mm defect, if the pertinent cortical wall is not perforated. Worst, he presented us yet unpublished data showing that the highest percentage of the failed implants because of early (periapical) periimplantitis is related to an implant placed in a site where a failed endo tx tooth was previously present, or adjacent to a tooth with an endo problem . Obviously, a CBCT scan may help to determine if a radiotransparency is close enough to a dental apex to be supposed as a endo problem, but a ethic question rises up about the probably unncessary exposition to X-rays of the patient asking for a simple implant surgery. So, caution should be taken when considering a mature site for implant placement, when the extraction were due to a fracture or endo problem or difficult extraction (remnants of infected endo filling!) and accurate debridement and bleeding of the alveolus should be provided when extracting a (endo tx) tooth, immediately placing or not an implant.
Hope this may help.
There is lit on this topic. For starters, read Shabahang 2003.
I have 4 failed apicos all on upper left side. I have just ext #10, leaving #11, ext #12, leaving #13 which is root canal only but clearly protruding sinus wall. This side of my face has severe facial pain that concludes to migraine in left eye. I did have socket preservation done for the extracted teeth, but I am wondering if I should have also extracted #11 since it is clearly a failed apico? But the issue is getting teeth or flippers there for the bone grafts to heal. Any advice…I need someone who could tackle my big problems in my upper teeth.
please, any advice can help me figure out how to proceed.
Natalie Cook,
By failed apicos I assume you have recurrent infection around the roots, correct? If so, my tendency is to remove the sources of infection (roots) and graft for future placement of implants. The common situation with failed apicos is the loss of bone and subsequent granulation tissue around the roots. This must be address during the extraction and grafting surgery. If you require teeth and you can’t live with a flipper, temporary implants can be used to support a prosthesis. I believe most dentists or specialists who have implant experience can tackle this situation. Just remember that there is no one correct plan as you will have different opinions depending on who you ask.
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