Infected Root Canals/ Molar Implants

Infected Root Canals/ Molar Implants

Infected Root Canals/ Molar Implants

Molars are the most common teeth to have a dental implant. It makes sense because we use the last molars more than any of our teeth for primary chewing.

Why Do Root Canals get Infected?

Most often molars are replaced from a root canal that did not work. The root canal tooth can crack or there is just not enough tooth to hold the crown on so it ends up being extracted. Sometimes a chronic infection is present around the end of the root canal because the crown leaks at the margin edge. This can be inflammation or infection and can change.

infected root canal x-ray
Infected root canal x-ray

There is a skill an art to replacing molars especially the last 2 molars.

The tooth numbers for the molars are #2, #3, #14, #15, #18, #19, #30 and #31. This does not count the wisdom teeth #1, 16, 17, 32.

Last molar dental implants can look really fake and can have problems like bone loss early on. In my practice I have a unique skill set that allows me to replace 90% of the molars that I extract on the same day of the removal!

Immediate Implants For Molars

The time saved by having any immediate same day last molar replacement is usually about 4 months. This technique gets you into a tooth faster than the traditional extract, socket bone graft and wait method. Both methods have their merits and I do both.

x-ray immediate molar
X-ray immediate molar guide pin to replace failed root canal. X-ray taken during surgery
x-ray molar dental implant
X-ray molar dental implant after restored with custom abutments and crown with good emergence

If the tooth does have infection it is very important that the infection is cleaned out all the way. Antibiotics are almost always needed at least before the surgery. The infection needs to be physically debrided out of the area and I often treat it with a special antiseptic directly on the bone to clear that out as well

The implant is typically placed in the middle between the roots. Because the implant is purposely smaller than the original tooth, a bone graft almost always needs to be placed into the void created between the implant and the socket walls.

Replacing molars on the same day of extraction requires a much higher degree of skill, experience and judgment. On the lower jaw a nerve is close by. In my practice I use some specialized instrumentation such as piezo electric surgery and osseodensification to make the procedure safe.

The biggest advantage to the same day replacement of the molar is that it saves time, money and yields the best or better result than a delayed replacement. By placing the implant on the same day the bone never gets a chance to shrink by disuse atrophy.

A method that I use to carefully control the shrinkage is by making a custom contoured healing abutment. This is a specialized custom piece to seal off the socket. It holds in the bone graft and help prevent the gum from creating a big dent. It takes extra time during the surgery to make but I find it has a lot of value. It makes the molars look really nice and helps the bone growth substantially. Other times I will use a carbon dioxide laser to shape the gums.

x-ray custom healing abutment dental implant
x-ray of custom healing abutment dental implant
guide pin dental implant x-ray
Guidance pin to place dental implant in proper position
root canal failing x-ray
root canal failing x-ray

Most patients are sedated for this procedure as removing a molar is difficult. Root canal molars usually come out in many pieces! Just yesterday I took one out in about 23 pieces! Yikes

I hope this helps you decide what to do with your bad molar!

Respectfully,

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, California

16 Comments

  1. Dara

    I have an infected implant on # 15. It was first infected after a failed root canal. The extraction in 2016 showed serious infection, it was cleaned and bone graft material placed there. I went on antibiotics and then had the implant placed. I now have an infection and bone loss again. Does this mean that the bone graft was unsuccessful? Should I bother with another bone graft or is my body going to reject it? I also have a root canal on #13 that is apparently failing also. It was infected in 2018 when the root canal was done. The oral surgeon mentioned space around the ligament. I think it should just come out but the oral surgeon feels an endodontist may be able to fix it. Thanks for your input.

    October 29, 2020 at 9:39 am Reply
    1. Ramsey Amin

      I would suggest you see a different provider. One that is very experienced an implant dentistry.

      Although bone loss can happen around an implant, having someone with a lot of experience in this field may help you prevent it in the first place. There’s a myriad of tiny details that need to be followed to prevent this from happening again. It is possible that the bone graft was never fully healed at the time that the implant was put in.

      Since this is an upper second molar you may get some benefit out of this particular post:

      https://www.burbankdentalimplants.com/last-molar-extracted-do-i-need-a-dental-implant/

      November 7, 2020 at 7:12 am Reply
  2. Dara

    I have an infected implant on # 15. It was first infected after a failed root canal. The extraction in 2016 showed serious infection, it was cleaned and bone graft material placed there. I went on antibiotics and then had the implant placed. I now have an infection and bone loss again. Does this mean that the bone graft was unsuccessful? Should I bother with another bone graft or is my body going to reject it? I also have a root canal on #13 that is apparently failing also. It was infected in 2018 when the root canal was done. The oral surgeon mentioned space around the ligament. I think it should just come out but the oral surgeon feels an endodontist may be able to fix it. Thanks for your input.

    October 29, 2020 at 9:39 am Reply
    1. Ramsey Amin

      I would suggest you see a different provider. One that is very experienced an implant dentistry.

      Although bone loss can happen around an implant, having someone with a lot of experience in this field may help you prevent it in the first place. There’s a myriad of tiny details that need to be followed to prevent this from happening again. It is possible that the bone graft was never fully healed at the time that the implant was put in.

      Since this is an upper second molar you may get some benefit out of this particular post:

      https://www.burbankdentalimplants.com/last-molar-extracted-do-i-need-a-dental-implant/

      November 7, 2020 at 7:12 am Reply
  3. robert stephenson

    Dr Amin

    As continuation of last inquiry, my gum around tooth very tender & if floss goes to gum line, that also starts pain.

    Thank you again

    October 26, 2020 at 10:29 pm Reply
  4. robert stephenson

    Dr Amin

    As continuation of last inquiry, my gum around tooth very tender & if floss goes to gum line, that also starts pain.

    Thank you again

    October 26, 2020 at 10:29 pm Reply
  5. Marisa K

    Hi Dr. Amin,

    Thank you so much for your blog. I am 35 years old and recently had tooth 18 extracted and a socket bone graft with non-resorbable membrane after a failing root canal. I had the extraction because even though no infection was showing on X-ray, I had pain that would go away on antibiotics.The tooth was removed a little over 2 weeks ago and it is still causing quite a lot of pain. I was on antibiotics (amoxicillin) for 1 week and went back to have sutures removed and the oral surgeon assured me that there was no infection. The area around the extraction is still painful (but is manageable with ibuprofen). Is it possible that I still have an infection? Would it still be normal to have pain this long after the extraction?

    Thank you for your thoughts!

    October 26, 2020 at 5:22 pm Reply
  6. Marisa K

    Hi Dr. Amin,

    Thank you so much for your blog. I am 35 years old and recently had tooth 18 extracted and a socket bone graft with non-resorbable membrane after a failing root canal. I had the extraction because even though no infection was showing on X-ray, I had pain that would go away on antibiotics.The tooth was removed a little over 2 weeks ago and it is still causing quite a lot of pain. I was on antibiotics (amoxicillin) for 1 week and went back to have sutures removed and the oral surgeon assured me that there was no infection. The area around the extraction is still painful (but is manageable with ibuprofen). Is it possible that I still have an infection? Would it still be normal to have pain this long after the extraction?

    Thank you for your thoughts!

    October 26, 2020 at 5:22 pm Reply
  7. I am so sorry, I didn’t ask my main question. It is a choice of apico or extraction.
    My endo recommended an apico today, it would be a month before he can do it.
    My oral surgeon recommended #13 should be extracted because it is loose and fragile, and said to return to him should it become reinfected.

    October 15, 2020 at 9:14 pm Reply
  8. I am so sorry, I didn’t ask my main question. It is a choice of apico or extraction.
    My endo recommended an apico today, it would be a month before he can do it.
    My oral surgeon recommended #13 should be extracted because it is loose and fragile, and said to return to him should it become reinfected.

    October 15, 2020 at 9:14 pm Reply
  9. I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    No antibiotic was prescribed today.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings. And still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research to decide asap.

    October 15, 2020 at 9:05 pm Reply
    1. Ramsey Amin

      It sounds that based on your medical condition that extracting the tooth in its entirety may be best. Apicoectomy’s are more successful on teeth with single roots such as your front teeth. Tooth #13 has a double root and although it is possible it may not have the longevity you are looking for. If your truly immunocompromised and take immunosuppressant types of medications it does make dental implants more difficult. Your body has to integrate the implant to the bone through a process we call Osseo integration.

      I would hate for you to have an apicoectomy only to end up having the tooth extracted later on.

      A loose tooth will not be fixed by an apicoectomy. In order for an apicoectomy to be successful it really needs to be a very solid tooth.

      Good luck and stay safe during COVID 19

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      October 21, 2020 at 12:23 pm Reply
  10. I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    No antibiotic was prescribed today.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings. And still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research to decide asap.

    October 15, 2020 at 9:05 pm Reply
    1. Ramsey Amin

      It sounds that based on your medical condition that extracting the tooth in its entirety may be best. Apicoectomy’s are more successful on teeth with single roots such as your front teeth. Tooth #13 has a double root and although it is possible it may not have the longevity you are looking for. If your truly immunocompromised and take immunosuppressant types of medications it does make dental implants more difficult. Your body has to integrate the implant to the bone through a process we call Osseo integration.

      I would hate for you to have an apicoectomy only to end up having the tooth extracted later on.

      A loose tooth will not be fixed by an apicoectomy. In order for an apicoectomy to be successful it really needs to be a very solid tooth.

      Good luck and stay safe during COVID 19

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      October 21, 2020 at 12:23 pm Reply
  11. Linda

    I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings.
    I still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research.

    October 15, 2020 at 9:03 pm Reply
  12. Linda

    I have a major decision to make and am very worried. I would very much appreciate your opinion. Last year I was found to have 3 major tooth infections. #3 and 14 were extracted under anesthesia in the OR last December. #13 got a root canal. The discomfort never fully resolved, but I was told to give it time to heal.
    It is now a year and today endo reevaluated it xray AND cone CT, and an abcess/inflammation has developed.
    Dr used both terms. After manipulation it is quite sensitive now. So its my 3rd infection in one year. I have been hospitalized for hyponatremia and my medical issues are extensive.
    I truly want the infection removed asap. Frankly I am terrified because I am at risk and I am immunosuppressed and got really sick last year,and needed long courses of two antibiotics.
    I am 57 year old and take good care of my teeth but have multiple caps and old fillings.
    I still need restoration of #3 and 14. Can immunosuppressed even get implants or are bridges my best option.
    Thank you for your thoughts, Im trying to do my research.

    October 15, 2020 at 9:03 pm Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!