Risks of Removing Old Crowns: Root Canal or Extraction?

The endodontist stated that removing the old crown may result in the inability to perform root canal treatment, and extraction may be necessary?

Hello Doctor, I would like to ask: The periodontist mentioned that the X-ray shows an inflammatory shadow at the apex of a molar tooth with a crown (it is not painful but has slight mobility).
I was referred to an endodontist for evaluation.
The endodontist said that because the crown has two pins and the material of the filling is unknown, it may not be possible to drill into it, so after removing the crown, the tooth may not be salvageable and extraction may be necessary.
Since this tooth will require a flap surgery later, I am concerned that if the crown is removed, the risk of losing the tooth remains high.
If root canal treatment is not performed, would performing flap surgery combined with apicoectomy to remove the inflamed tissue and retrofill be another viable option? I have not made a decision yet and plan to consult both specialists together at a later date.
I would like to know if this approach is feasible so I can discuss it with the doctors.

SKY, 50~59 year old female. Ask Date: 2022/05/13

Dr. Zeng Guanghui reply Dentistry

If the X-ray of the molar that originally had a dental crown shows apical inflammation along with bone resorption around the root, in addition to root canal treatment, periodontal treatment is also necessary.
In cases where root canal treatment is performed with a post in place, if the post cannot be removed, the only options to consider are flap surgery and apicoectomy.
It is recommended to have a collaborative consultation with both a periodontist and an endodontist before making a final decision.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/05/13

More Info

When dealing with dental crowns, particularly in cases where there is evidence of inflammation at the root apex, it is essential to consider the potential risks and treatment options carefully. The situation you described involves a tooth with a crown that has shown signs of inflammation on an X-ray, which could indicate underlying issues such as infection or root resorption. The fact that the tooth is slightly mobile and not painful suggests that there may be some structural compromise, but it does not necessarily mean that extraction is the only option.

Risks of Removing Old Crowns
Removing an old crown can pose several risks, particularly if the underlying tooth structure is already compromised. The primary concerns include:
1. Damage to the Tooth Structure: During the removal process, there is a risk of fracturing the tooth, especially if the crown has been in place for an extended period and the tooth has undergone changes such as decay or structural weakening.

2. Infection Risk: If the crown is removed and the underlying tooth is not adequately treated, there is a risk of introducing bacteria into the tooth structure, potentially leading to further infection.

3. Loss of Retention: If the tooth is already weakened, removing the crown may lead to a loss of retention, making it difficult to place a new crown or perform other restorative procedures.

4. Need for Additional Procedures: Depending on the condition of the tooth after crown removal, additional procedures such as root canal therapy or extraction may be necessary, which can complicate treatment and increase costs.

Treatment Options
Given the complexity of your situation, there are several treatment options to consider:
1. Root Canal Treatment: If the tooth is salvageable, performing a root canal may be the best option. This procedure involves removing the infected pulp tissue, cleaning the root canals, and sealing them to prevent further infection. However, as your dental specialist mentioned, the presence of the crown and the materials used during the initial treatment may complicate this process.

2. Flap Surgery and Apicoectomy: If the root canal is not feasible or if there is significant infection, flap surgery combined with an apicoectomy (removal of the root tip) may be a viable alternative. This approach allows for direct access to the inflamed tissue and can help to clear infection while preserving the tooth structure as much as possible.

3. Extraction: If the tooth is deemed non-restorable, extraction may be necessary. This is often considered a last resort, especially if the tooth is critical for function or aesthetics.

4. Consultation with Specialists: It is wise to seek opinions from multiple specialists, as you are planning to do. A collaborative approach can provide a comprehensive view of the best treatment options available.

Conclusion
In summary, while the removal of an old crown carries inherent risks, there are various treatment pathways to consider based on the condition of the tooth and surrounding structures. The decision should be made collaboratively with your dental team, taking into account the specific circumstances of your case, including the potential for preserving the tooth versus the risks associated with extraction. It is essential to weigh the benefits and drawbacks of each option carefully, and to ensure that any procedure undertaken is done with a clear understanding of the goals and expected outcomes.

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