Molar root removal question

[groundhog]

Bad news today. I found out that one of the roots in my lower right molar next to the biscupid needs to be removed because of decay under my crown. My dentist is going to refer me to an OMS for the work. My dentist tells me that he will then be able to save the crown before the decay gets over to the other root. I said maybe I should just consider an extraction followed up by an implant. My dentist said that was an option, but he would recommend the root removal due to the difference in over all costs and the fact that the tooth will be difficult to extract because it has had a root canal.

So, what would do the real experts (Dr Jeff et al) on this forum know about my situation? Is it a rare occurrance or not all that uncommon for folks my age (late fifties early sixties)? Also can anyone tell me what is involved in removing a root from said molar that also has a crown on it? I imagine it to be an unpleasant ordeal but then maybe not. I asked my dentist if the OMS goes in from the side of the gum to get the root. He did not know for sure how the procedure would be done.

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[UBTom]

Hi Groundhog,

Standard disclaimer: I haven't seen your chart or your x-rays so take my advice with a grain of salt. Here's my opinion:

It's a third molar. It's all the way in the back of your mouth. It's difficult to keep clean, as is evident with the presence of decay. That's why I don't think it's worth saving, particularly if they are going to resect one root, which will only create a bigger debris trap under that crown and cause even more decay down the road. At best you might be able to get maybe a couple more years of use out of it, and it might not be worth the investment in effort or money.

I'm a believer in the axiom that simple treatments work best... Maybe it's the influence of my instructors here at my school. Just extract the whole thing and be done with it. In most cases third molars don't need replacements anyway.

My almost-professional opinion.

2 months from now it will be a fully-qualified professional opinion.

 

[groundhog]

UB,
I have to apologize to you. I was too ambiguous regarding the location of the molar. To be more exact it is the lower right molar that is next to the bicuspid. I guess I should have described it as the first rather than third molar. Anyway, your suggestion may be different given the new information. I will edit the original post so as not to confuse others. Thanks for your help.

 

[dudelove]

I assume you are talking about root amputation? That is just textbook stuff. People rarely do it becase it involves a root canal(I guess you already had one) and a crown ontop of an oddly contoured tooth due to the missing root and thus makes things harder to clean. I haven't seen your case, but if it's a 3 molar why bother with the expense and pain. If it's not a 3rd molar, I would seriously think about an implant. The implant can't decay like the remaining root will one day. The implant will cost you more out of pocket, but it will pay off in the long run. Good luck.

 

[groundhog]

dudelove,
I apologize to you too (reread my original post which I have edited to more accurately describe the tooth in question).

 

[UBTom]

to Groundhog:

Ah yes. It does make the situation clearer-- That tooth in question is what we dental professionals would call a First Molar, NOT a third molar. A third molar is a wisdom tooth, and those are usually expendable.

On the other hand, a first molar is indeed an important tooth to keep. However, as I said before, root amputation will only create a bigger debris trap under that crown and the prognosis for that tooth will remain poor. I agree with Dudelove-- An implant is the better option in the long run because like he says it won't decay, and it will be easier to maintain.

Heck, if you go through with that root resection, two or three years from now you will probably still lose that tooth and have to go for an implant anyway.

HTH.

 

[dudelove]

What I would advise is a second opinion for you. That being said, root amputation is textbook stuff, we rarely do it in private practice. Why? Because it isn't worth the time, money and expense. The tooth will probably end up decaying anyhow. An implant would be a great option as ubtom said. As I said though, you might want to seek out a second opinion. Good luck!

 

[DrJeff]

100% get the implant. Long term its the only way to go. If you have them do a root amputation(hemisection is our "fancy term") now, you suddenly taken away about 1/2 of the support structure of that tooth. This being a molar where you do the vast majority of the heavy grinding, alot of daily stress and wear and tear are placed on that tooth and it needs to be able to hold up. (Remember there is a reason why mother nature made molars BIG, so that they'd have the surface area to distribute the masticatory forces that they'd encounter)

Now, if you get the tooth hemisectioned now, you'd likely see a few good years of service, followed by the failure of tooth due to periodontal(bone loss) of the remaining root. When this situation comes up for one of my patients, how I'll describe it is as follows: Picture your tooth as a house built on stilts, now remove one of those stilts. is that house still as strong as you want it??

By having the implant done, you 'll have a 100% supported molar for grinding, and frankly as long as your not a chain smoking diabetic, the success rate is about 100%. Thats the big thing, the long term success rate. A hemisectioned molar will have a success rate at 5 years in the 50-65% range, that same tooth as an implant will have a success rate at 98%+.

Think about it this way, if you pay to have the tooth hemisectioned now, there's a strong chance that in the next 5 years you'll also be paying for that implant. Save yourself the extra procedure fee and have the oral surgeon just place the implant instead of hemisection the tooth. You'll be getting beter dentistry in the long run, and frankly if it was my tooth(or any of my relatives for that matter) I wouldn't even think twice about the hemisection and go straight to the implant.

 

[groundhog]

Thankyou Dr Jeff, UBTom, and dudelove.

I am much more comfortable now about approaching the OMS with the idea of the implant.