Quality & Affordable Dentistry in Malaysia

Dental Implants vs. Root Canal Therapy in Selangor, Malaysia

Posted by dentist3 in Dental Articles | 0 comments

The inside of a tooth is made up of a nerve, artery, vein, and much smaller arterioles, veinoles, and tiny branches of nerves
The inside of a tooth is made up of a nerve, artery, vein, and much smaller arterioles, veinoles, and tiny branches of nerves

Dental Implants vs. Root Canal Therapy in Selangor, Malaysia

Endodontics (Root Canal Treatment)

Endodontics or root canal therapy has been the treatment of choice to save infected, injured, and exposed (nerve exposure) teeth for many years now. The procedure cleanses all vital tissue within the tooth’s pulp chamber. This includes the portion just under the dentin layer of tooth in both the coronal and root portions. This tissue is made up of a nerve, artery, vein, and much smaller arterioles, veinoles, and tiny branches of nerves. If the tooth is totally dead and there is no pain emanating from it, no local anaesthetic is administered before treatment.

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Then, an opening is made with a hand-piece and bur through the crown portion of the tooth into the pulp. Usually, a channel is established a few millimetres down into the root portion of the pulp canal with a set of carbide steel burs of progressively increased diameter. These are driven with a slow speed hand-piece. Then small files, also of increasingly larger diameter, are placed into the canals by the dentist’s hands. The tedious task of cleansing and enlarging the pulp chamber is carried out while extreme care is taken to not go any farther than the very end of the root.

Today, many dentists use mechanical files attached to hand-pieces to perform this procedure. Still, a lot of doctors feel more comfortable with the finger-held method. A series of irrigation solutions rinse the canal during treatment. Upon completion and final irrigation, the canal is dried with specially manufactured absorbent sterile paper points. A special sealant type of cement is usually placed inside the canal, wetting all of the internal surfaces; and then, before setting, an inert material, usually gutta percha, which has been pre-sized and fitted, is  placed into the canal. Smaller gutta percha points are placed peripherally around the main one and all of these are compressed or condensed with special instruments designed just for this purpose. They are heated at the appropriate times to aid in the coalescing of all of the gutta percha into one mass. The external surface of the tooth is then sealed with a dental cement, often of temporary nature.

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Throughout this whole process the dentist has been using radiographs or a sonic depth finder to establish the length of the root and thus continuing to work within this established depth only. It can be harmful if the operator goes beyond the root and into the bone; so every effort is made to avoid this pitfall.

Sometimes a significant portion of the crown of a completed root canal tooth is missing due to prior decay or accidental injury. When this occurs, the general dentist will go through a new series of steps, usually a few days later to fit and place a post into the treated canal. This post can then be built up with the appropriate dental materials to simulate the structure of a natural crown preparation. Then, the dentist trims this to an ideal size and form, and takes an impression in the conventional manner. A temporary crown is then crafted and placed until the new crown arrives back from the laboratory.

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The crown of an endodontically treated tooth is not always damaged badly enough to warrant this in-between step of a post. When this is the case, a dental crown is made, nevertheless, because the tooth being void of all its nutrition is now dry and becomes increasingly brittle. A crown will protect it and also tie it together by totally surrounding the coronal portion of the tooth.

What are the disadvantages of undergoing root canal therapy? Some patients complain of pain during treatment. This usually occurs because of incomplete local anaesthesia. When a tooth has an infection at the end of its root, the level of body acidity to base ratio may be altered in that area.

That being the case, the local anaesthetic may not work completely, or even at all, in some cases. The dentist can usually overcome this by changing the type of anaesthesia given and she may also administer nitrous oxide and/or pre-operative pain controllers, usually orally. After the first appointment and the nerve of the tooth has been completely eradicated, seldom do patients experience further treatment discomfort: But today, even the first appointment is usually uneventful.

The second disadvantage is that nothing in dentistry or medicine is 100 percent and while root canal therapy enjoys a very high success rate, failures do occur. When this happens, there are three basic alternatives: 

1) retreat the tooth in the conventional manner as previously described; 

2) surgically intervene and amputate the end of the root while cleaning all adjacent bone tissue, then retrofill it to create a new seal at the end of the root; and 

3) extract the tooth. 

If any of these three events must occur, a patient is likely to wish he had opted for the extraction in the first place, warranted or not.

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Another disadvantage is that all teeth, after being treated endodontically, require a dental crown to be placed so that the newly devital tooth will not break or fracture as it becomes increasingly brittle due to lack of nutrients and fluids. However, if extracted and if an dental implant is placed, a crown will be required also. And if extracted and no implant is placed, a fixed bridge or removable partial denture will be required to replace the missing tooth.

The final possible disadvantage may be that a tooth can never be cleansed and filled to maintain complete sterility and that all completed root canal teeth harbour microbes, especially anaerobic (requiring no oxygen) bacteria. If this is true, health ramifications far surpass dental considerations. This subject like so many others in health, medicine, and dentistry is highly controversial and has adamant supporters on both sides of the issue. More research and study need to be accomplished on this issue.

Dental Implants in Selangor, Malaysia

Dental Implants are used to establish anchors for fixed crowns, bridges, removable and partials. They are placed at extraction sites. They simulate natural tooth roots and their crowns. Their advantage, however, lies in the fact that they are usually inert in regards to foreign materials being placed within human tissue. And they are seldom sloughed of or rejected by the bone tissue they are placed within. Nor do they harbour the bacteria that are often found within and immediately surrounding the bone that supports endodontically treated teeth.

They are made of biocompatible metal, usually surgical titanium, and are often coated on their outer surfaces with hydroxyapatite (HP). This tends to further insulate them from the surrounding bone and encourages normal healing with less chance of allergic or other reaction. Bone seems to integrate (osseous integration) with the HP coated implants, or will, as it does with the raw metal ones. This integration takes from three to six months or longer and assures that the implant is firmly anchored into the bone. Then, at that time, a crown or bridge or other dental prosthesis can be constructed and placed on top of the implant. There may be precision attachments that interface in between the implant and the prosthesis. 

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The nature of these artificial dental implants is such that it is literally impossible for them to harbour bacteria internally and, in most cases, they are relatively free of infection within the bone in which they reside.

The biggest disadvantages of Dental implants are: 

1) they are more expensive generally than root canal treatments; 

2) a full surgical procedure is always required during implantation and usually a more minor surgical uncovering at the time just preceding prosthetic construction; 

3) there can be pain, swelling, and general discomfort following surgery; 

4) occasional rejection of the dental implant; and 

5) post-operative infection can and does happen, even if not very often.

Patients must be made aware of these possibilities and they should weigh these against benefits and then consider the alternatives of either root canal treatment on one hand or going without anchor teeth and settling for removable prosthesis in the form of partial or full dentures. 

On the other hand, a complete disclosure to the patient and discussions between the dentist and patient are essential. When this occurs, the patient can make an intelligent choice that is appropriate and an informed consent will have occurred between both parties.

The coronal and root portion of a tooth before filling with root canal filling.
The coronal and root portion of a tooth before filling with root canal filling.
Filled with gutta percha after filling root canal.
Filled with gutta percha after filling root canal.
Post placed in a root canal tooth. Third tooth from the back on lower left side of photo.
Post placed in a root canal tooth. Third tooth from the back on lower left side of photo.
Third tooth from the back on the lower right of photo.
Third tooth from the back on the lower right of photo.
Decay under bridge on second bicuspid.
Decay under bridge on second bicuspid.
Second tooth from back infected (dark area between roots).
Second tooth from back infected (dark area between roots).
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