The only alternative to root canal treatment is the extraction of the problematic tooth. It is wise to consider all of the implications of losing a tooth before having it removed. The decision should not be made hastily or because the tooth is painful. If pain is present and the dentist thinks that the tooth can be saved, the discomfort can first be relieved and then the alternatives explored.
The discussion about tooth replacement alternatives after extraction can be complex because each individual situation is unique and, at times, various specialists may need to be consulted. When considering the alternatives for replacing a missing tooth, a few of the major factors to consider are the long-term predictabilities of the various alternatives, the overall chair time involved in treatment, the esthetic results, the effects on the adjacent and opposing teeth, and the costs. The usual alternatives that a patient has after tooth extraction are:
A restored dental implant:
This restoration involves a surgical procedure to insert the dental implant into the bone, a healing phase of several months, and a final restorative phase, which is similar to having a single tooth crown. Significant time and laboratory costs are involved.
A fixed bridge:
Fabricating a fixed bridge requires cutting down (“preparing”) the teeth next to the missing tooth so that they can receive the artificial crowns that support the replacement tooth. These teeth must be strong and healthy if they are to be effective bridge supports. Preparing the teeth for crowns could have a detrimental effect on their pulp health, depending on a variety of factors. This possibility needs to be discussed and factored into your decision. Fixed bridges may take multiple appointments to complete and have significant associated costs.
A removable partial denture:
These appliances restore function and esthetics and can be inserted into the mouth and removed at will. Although many teeth are successfully replaced with removable prosthetic appliances, patients may initially find them cumbersome. Removable partial dentures may also temporarily alter phonetics as well as place unfavourable forces on the supporting teeth and soft tissues. There may be significant costs associated with this restoration.
Not replacing the extracted tooth:
This is a poor choice in most situations. Leaving a space after extraction can lead to long-term problems with teeth shifting and tipping, destabilization of the biting system, and esthetic changes in the profile of the face. Financially and psychologically, this could turn out to be the most costly choice over the lifetime of the patient.
After considering and weighing all of the consequences of extraction and all of the alternatives for tooth replacement, in most situations it becomes obvious that well-performed root canal treatment with a protective restoration is the treatment of choice. Root canal treatment is usually the least time-consuming.