Can I Place Implants Adjacent to Failed Root Canal Treatment?

Dr. C asks:
I am a general dentist and I restore implants but I do not surgically place them. I have a new patient referred to me by a colleague who presented with the chief complaint of throbbing pain, “somewhere on the right side”. The patient is a healthy, 44 year old female. All the upper and lower premolars and molars on her right side have single metal ceramic crowns. Upon probing the periodontal pockets I found furcation lesions on all the molars. The crown margins fit very well. My radiographic examination shows multiple, catastrophic root canal treatments with post perforations, gutta-percha extending way beyond the apices, interproximal bone loss and many radiolulcent apical areas.

Regardless of where her current pain is coming from, my problem is that her upper right canine [#6; 13] is the abutment for a fixed partial denture that was recently removed by a periodontist who together with prosthodontist have treatment planned for a 4- unit anterior fixed partial denture with 2 implant abutments. Is it good practice to place implants next to obviously failing endodontics?

I attended a restorative dentist implant failure lecture in 2008, where it was stressed that implants and bacteria have opposite surface charges, and even seemingly good endodontics can form sinus tracts in the direction of the implant because of this phenomenon. She has taken out a loan to afford the implants and anterior fixed partial denture, as she cannot afford the treatment out of hand. Will the implants fail if they are adjacent to failed root canals? What should I do for this patient?

14 Comments on Can I Place Implants Adjacent to Failed Root Canal Treatment?

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sb oms

12/6/2010

do the right thing. failed root canals are infected by definition. in dental school we learned to clear the mouth of infection before beginning reconstruction. it is your job to tell the patient what they need to do first. do not let money confuse basic dental principals. and yes, don't put implants next to infected teeth. sounds like this lady may need a few months in a treatment partial.

Gregori M. Kurtzman, DDS

12/7/2010

The endo needs to be treated before implant placement adjacent to it or the bacteria associated with endo could lead to implant failure during healing.

Robert Buksch

12/7/2010

Retreat the failing endo or extract and replace with another implant. It will cost much more if the restoration fails due to proximity of the infection. Advise your patient to ask questons, first give your colleague a heads up about what you are about to discuss with your patient.

Dr. Vaziri

12/7/2010

Do nothing.What ever it's gone, it's gone. If you want to do something for the patient as a dentist,just clean up the mess. This is the way how it's work for a patient. Good Luck to you. Dr. Vaziri from Iran.

12/8/2010

I'd like to see a pano or other x-rays. It sounds like you know what's reasonable and are just looking for some confirmation. Lesions of endodontic origin definitely pose a risk to adjacent implants. If you are going to be involved in the case make sure your new patient is on board with you being the quarterback. Let her know that her problem is bigger than just the bridge she lost. When you explain that she is going to lose more teeth, it's easy for her to understand that it's best to make a treatment plan to consider the whole mouth. Good Luck

Dr N

12/8/2010

I have a similar case. Thera are 2 teeth (second premolar and second molar in mandible) endodontically treated, but not good and have metal posts. Patient wants implant in region of first molar. Should I place it because there is no evident inflamation,not any translucency on the apex of that roots?

peter fairbairn

12/8/2010

The worst case senario is when you are referred the case and tell the patient that the endo needs to be redone before placement. Upon which the patient replies that it has only just been done ( short) and now they want to sue your referring dentist.......goodbye referral source So there are many issues here , most implant cases are in the last chance saloon with many failing endos , it is a delicate situation. If they do not want to re-do ( they have no symptoms ) what then or do not have the budget ? I just note it as a risk and tell the patient. We are going back to the old Endo v. Implant argument which is always fun..

Dr. Vaziri

12/8/2010

Dr N. As long as adjacent teeth with poor endodontically treated and NO sign of infection or periodontal disease, that fine you can place implants. If endodontically treated teeth are 2 years or less prior to placing an implant You should fallow up the patient with supervision on hopeless teeth for at least 3 years. Good Luck to you. Dr. Vaziri from Tehran Iran.

Dr. MM

12/9/2010

In regards to your fist question, in my books placing an implant next to an endodontically failing tooth is on the no no page. In regards to your second question, like sb said " do the right thing". first address her major complaint which is"throbbing pain", second get on the phone with the other 2 treating dentist to discuss a comprehensive treatment plan that will benefit your patient, who is in pain.

V.Assadi

12/13/2010

I do agree with Dr.MM. But for plan B,As some of her failing RCTs are combined with perforated posts, I think there is noother way than extraction. The best thing to do in this situation is 1- extraction of at least premolars of right side of her upper jaw in order to put actual foci of infection as far as possible from your implants, then put 4 implants in 14,13,11 and 21, with 22 and 15 as cantilevers with minimal or no occlusal contacts on them.Obviously, relieving that throbbing pain is the most important part of the question, which must be addressed, and for a long time concept of treatment, all failing RCTs must be addressed, endodontically or surgically(extraction or apicoectomy). V.Assadi, Iran

Ian

12/29/2010

All root canals are failure with regards to infection. Even if they appear fine radiologically they always harbour infection. See: http://jada.ada.org/cgi/content/full/132/2/191 Yes, if next to root canals, they will fail (eventually). Forget the implants, that patient needs surgery to remove the chronic infection in her jaw, along with the removal of the failed root canals.

dr.milap

2/11/2011

i think u should first plan for the failed root canals.. clean up the mess.. do re root canal and then plan with the implants.. its fundamentally not correct placing implants next to infected root canals.. chances of implant failure increases and i dnt think u want that

Richard Hughes, DDS. FAAI

2/11/2011

Rempne the infected tooth, bomb the patient with the proper antibiotic, give the site some time, then place the implant.

Richard Hughes, DDS. FAAI

2/11/2011

The first word in my thread should be remove