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Upper left 2nd molar RCT or Implant

I have been getting different answers by two of my personal dentists (both general DDS) on treatment of my upper left 2nd molar that has sensitivity. Planning ahead I have asked my uncle (DDS, doesn't do implants) and he said that he normally doesn't do RCT on upper 2nd molar because of location and multi canals. My normal doctor said she will refer me out if I want an implant, but can do a RCT. Is this odd? My uncle's not willingness to do RCT. Is it a sign that a Endo should do it? Can general DDS do implant upper 2nd molar?
Poster
  • Male | 28 years old
  • Complaint duration: 10 days
  • Medications: prevident, motrin 800 mg, night guard
  • Conditions: sensitivity to cold, sensitivity to very hot, previous deep filling, receding gum

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Featured Answer

1 UpVoted this answer
I personally do not favor implants in the second molar area as a norm unless it is absolutely necessary for function due to likely complications with the maxillary sinuses. If the tooth can be restored, I would always favor saving the tooth with a root canal, core, and crown. Properly done root canals when properly restored can be very predictable. In fact, there are some interesting new journal articles that are showing that the success rates of dental implant/restoration complexes have similar survival rates to conventional restorations.

Well-trained and experienced general dentists can do molar root canals, but I tend to refer them to an endodontist (specialist for root canals) simply because second molar root canals can be tricky.
1 UpVoted this answer
This is a complex question. Any second molar for anyone is especially difficult due to location and multi canals like your uncle said. But the experience and more regularity in doing these of a specialist is by far a better option. This does not mean a general dentist cannot do these well. However many feel they do not want to or do not feel comfortable enough doing these. Second molars sometimes do not need to be replaced and many patients function and live very well without them. get ALL your questions answered well before making a decision.
Nilo Hernandez
1 UpVoted this answer
Many general dentists can become as competent or more competent than endodontists at doing root canals. It comes down to skill practice and interest level. That being said, I agree with your uncle that an implant is a more predictable and long-term solution for a young person.
Lawrence D. Singer
1 UpVoted this answer
There are a lot of considerations here. If you have the tooth extracted, how much bone do you have below your sinus to place an implant. What is the health of the surrounding tissues, the adjacent teeth? A root canal in this area should really be done by an endodontist, preferably with a microscope. Should you choose to have the tooth extracted, have an oral surgeon do it and have the site grafted in preparation for a future implant.
1 UpVoted this answer
You state you're "thinking ahead" here, but I would stress that these dental alternatives are steps away from your healthiest position, which hopefully is attainable by working to help your tooth return to being comfortable and strong. Don't be too quick to give up on your sensitive tooth. If your dentist and hygienist are not offering you advice and help to reduce the sensitivity, find another source for this. Do your own research; find out what you can do to reduce sensitivity. If necessary, consider some of the leading products available, but be mindful of toxic ingredients often found in these. Strategies to buy time for the nerve to adjust and calm down include avoiding the cold and hot stimuli that irritate it. "Baby" the tooth, avoid chewing on it. Above all, don't be too quick to give up on your tooth if you can live with it.

If you can't live with it, and are seriously considering root canal therapy, I would suggest a couple points. Many general dentists "do" root canals, but a good root canal specialist, an endodontist, has significantly higher levels of training, experience, and dedication toward these technical procedures, important factors toward achieving long term success when treating this often difficult tooth. You state your age is 28; that's pretty young to lose this molar. But if this becomes necessary, and you choose to replace the tooth using an implant, again I would urge caution in choosing a general dentist to place the implant in this site, especially with the sinus so near and bone quality often being softer here. Consider getting an oral surgeon with a good reputation placing implants to evaluate the area with a 3D x-ray, which is now the accepted standard. If a sinus graft is needed for an adequately long implant, it needs to be done right. Implants can fail; root canals can fail. Both these procedures carry compromises to your general health. Try and keep your tooth. Good luck!
Gregory G. Zimmer
1 UpVoted this answer Vasant Ramlaggan, D.D.S., H.B.Sc. Dentist, Toronto
A general dentist is licensed to both place implants and do molar root canals. Not every dentist is qualified to do either of those procedures however. I takes both continuous education and experience to become proficient at doing those types of dental work Also, it is not at all unusual for a dentist to choose not to do certain procedures that he/she does not like or is not very good at. There are so many treatments that can be done, sometimes a dentist will only focus on some and not routinely do others.

As for which procedure would be best for you, I will give you this opinion: a root canal is less expensive and more conservative that removing the tooth and placing an implant. A root canal will, in all likelihood, serve you well for many years. That being said, an implant, placed well, should last you the rest of your life and is significantly more predictable than a root canal in the long term.
1 UpVoted this answer
Great and interesting question! Since it is impossible for me to give you a diagnosis and treatment plan due to the lack of information about the tooth, I can address your concerns with broad generalities. First, if the tooth is able to be restored, you should try to do so. If your dentist or your uncle don't do root canals on upper second molars (mainly this is due to either inexperience, lack of interest or, most likely, difficulty with the access--this tooth is very difficult to treat), then you should seek referral to an endodontist--they treat these teeth ALL the time. Second, ANY dentist with training can do root canal therapy on a properly chosen second molar--find one that has it. Third, I do not, as a rule, prefer implants to conventional restoration of an upper second molar for several reasons--1-the access for implants is as complicated as the access for root canal therapy. 2-I've placed hundreds of implants and find that, in the upper second molar region, either there is no bone (due to the presence of the sinus) or that the quality of the bone is poor relative to that of most other areas in the mouth (think of trying to secure a screw into a dry sponge vs. solid pine or oak wood). 3-Because most patients will have had upper wisdom teeth removed (or they never had them to begin with), it is quite likely that a patient with a normal bite can simply have an upper second molar removed and NOT require a replacement. I have found that many upper second molars are subject to gum disease in the later middle decades of life--removing them allows better home care for the remaining upper first molar and does NOT affect the patients ability to chew. Have your dentist evaluate your bite for that option. Good luck!
1 UpVoted this answer
This is sort of an apples vs. oranges question. Over time most general dentists (i am one) develop their own special expertise in different procedures. Upper second molars can present endodontic challenges so some GP's will send them all out to a specialist. Other GP's will do most of their own or will send to a specialist if they project from the x-ray that the case will be difficult.

As far as implants are concerned, the upper second molar area can be very challenging since that is also the location of the maxillary sinus. There is a possibility that an implant can not be placed there or only can be done if a sinus lift is done. This should only be done by practitioners who have a good deal of experience doing these procedures. There are qualified GP's who will do this but this is not usually the case.

Although I am a proponent of implants where indicated, I would recommend the root canal therapy as long as there is sufficient tooth structure and that you also commit to getting a crown and possibly a post-core.

I would also ask whether a course of sensitivity treatments would be appropriate for the tooth. Since you did not specify the level of discomfort that you have..
A root canal on a 2nd molar sometimes requires the expertise of an endodontist because of the close proximity of the sinus floor. Trust your uncle the dentist.
It depends on the the overall condition of the tooth, the size of the decay and the amount of bone surrounding this tooth Endodontics is a predictable procedure for molar teeth. Depending upon the comfort level of the DDS they may elect or do it or refer to an endodontist who is more experienced. Following the root canal the tooth would need to be crowned. If this treatment can not predictably give you 5-10 years of service then you may elect to do an implant. If you are looking for a one and done solution then an implant may be the way to go
James A. Vito