A tooth that has undergone a root canal procedure can be extracted, or “pulled,” if necessary. The root canal procedure, or endodontic treatment, is performed to save a diseased tooth by removing the infected pulp tissue and sealing the interior root canals. While this treatment aims to preserve the tooth structure for a lifetime, complications can arise later that make removal the only viable option. Dentists prioritize saving the tooth, but extraction becomes necessary when the damage or infection is irreversible.
Reasons for Root Canal Failure
A tooth may require extraction after a root canal due to structural integrity or persistent infection. A primary concern is a vertical root fracture, a crack that starts in the root and moves toward the chewing surface, which cannot be repaired and allows bacteria to re-enter the tooth. Root-canaled teeth are more susceptible to fracture because they lose internal moisture after the pulp is removed, making them more brittle over time.
Infection can also persist or recur if the initial cleaning was incomplete, especially if the tooth has complex anatomy with missed canals. Bacteria can remain in these inaccessible areas, leading to chronic inflammation and bone destruction around the root tip. Furthermore, a failure in the final restoration, such as a leaky crown, can allow oral bacteria to bypass the seal and reinfect the canal system. This reinfection often creates a periapical abscess, requiring removal if it cannot be resolved.
Alternatives to Extraction: Saving the Tooth
Before recommending extraction, dental professionals explore options to save the tooth, as preserving the natural tooth structure is preferred. The first alternative is non-surgical retreatment, which involves reopening the tooth to remove the old filling material, thoroughly cleaning and disinfecting the root canals again, and then resealing them. This procedure is most successful when the initial failure was due to incomplete cleaning or a faulty seal.
If the infection is localized to the root tip and inaccessible through the top of the tooth, a minor surgical procedure called an apicoectomy may be performed. An apicoectomy involves making an incision to access the root tip directly, removing the infected root end and surrounding tissue, and then sealing the root canal from the bottom. This surgical approach is used when retreatment has failed or is not feasible, provided the tooth is otherwise structurally sound.
The Extraction Procedure for a Treated Tooth
Extracting a tooth that has had a root canal is often more complex than removing a tooth with a healthy nerve. Since the tooth loses its internal blood supply, the dentin becomes brittle and prone to fracturing during the procedure. This brittleness means that traditional extraction forces are likely to cause the tooth to break into small pieces within the socket, complicating removal and increasing the risk of leaving fragments behind.
Because of this fragility, the procedure may require a surgical approach, even for a tooth that appears straightforward. The dentist or oral surgeon may use techniques like sectioning, where the tooth is intentionally divided into two or more pieces to be removed individually. After the tooth is removed, it is crucial to thoroughly clean the socket, removing any infected tissue, abscess material, and fragments of the old root canal filling material. This careful debridement prevents residual infection and prepares the site for optimal healing.
Replacement Options After Tooth Removal
Once the root-canaled tooth is extracted, replacing the missing tooth is strongly recommended to prevent long-term complications. Leaving a gap can lead to shifting of adjacent teeth, affecting the bite, and causing bone loss in the jaw. The three main options for replacement offer different benefits depending on the patient’s health and budget.
Dental Implants
Dental implants involve the surgical placement of a titanium post into the jawbone to act as an artificial root, topped with a crown. Implants provide the most stable, natural-feeling replacement and help preserve jawbone density by stimulating the bone.
Fixed Bridge
A fixed bridge uses the adjacent healthy teeth as anchors for crowns, with a false tooth suspended between them to fill the gap.
Removable Partial Denture
A removable partial denture offers a less invasive and often more affordable solution, consisting of a plate with a false tooth that clips onto the remaining teeth.