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

30 thoughts on “Infected Root Canals/ Molar Implants”

  1. i had a RTC on my left bottom tooth molar region and my top inner cusp cracked it is somewhat painful but my question is, i was sent to the endontist by my dentist prior to having a perm. crown placed, will i now have to have an extraction if the tooth split at the cusp, i can actually wiggle that corner. I called both offices and they both said go back to one another, who is responsible it was only a week that i had the procedure M-Thur it occured, I also noticed in my 3d xray a dimesized circle or hole just before the teeth so i guess mandible area. what does that indicate?

    Reply
    • Oof. The dentist who is making the crown will determine if it can still be saved. Sadly this happens and it is no one’s fault…not even yours. The tooth was probably to weak to begin with. 😰

      Reply
  2. Hi,

    My first molar(upper left 15) on the left has been extracted. My second molar on the left side(upper left 14) is vertically broken. The broken piece has been extracted and the remnant is intact. Is it possible to perform a root canal on the remnant tooth and thereafter place a crown bridge covering wisdom, first molar and second molar (upper left 16, 15, 14). I am 53 years old male. Many thanks in advance.

    Reply
    • Using an upper wisdom tooth as a bridge anchor is almost never a good idea. Most people do not have big enough roots and the oral hygiene is difficult. This leads to failure very often. Sorry

      Reply
      • Many thanks. My dentist says that root canal can be performed after cutting some portion of the gum and inserting a post / stump to support the remnant half tooth. My only concer is whether it is advisable to perform a root canal on a broken tooth supported by a post.
        Please advise and thanks again.

        Reply
          • Thanks. But my query is whether it is advisable to perform root canal on a broken teeth and support it by a stump / post.

          • If there is enough tooth for this to be predictably restorative then this can work. This is called a post and core. That being said, many of these are done in a very heroic manner and the teeth and up fracturing. Many of them end up getting extracted and having implants. It all depends on case-by-case diagnosis and treatment plan.

  3. Hi there, I am 37 years old. Facing extraction of tooth 31 due to fracture and failed root canal. I am so scared to get the tooth pulled, and not interested in an implant. Will missing this 1 tooth affect me much? I dont have my wisdom teeth. My other teeth are healthy. Thank you

    Reply
    • Hi Julie – if you extract 31 and do nothing. The tooth above it… #2 Will over erupt.

      As the article says this will depend on your bike and how much of upper molar makes contact with remaining tooth 30.

      Ideally this tooth is replaced with an implant but keep in mind that dental implants are elective and not required for all situations.

      Reply
  4. Hello Dr. Ramsey, my upper implants placed using the cement abutment method with silver metal ten years ago. One crown has fail off, and the odor was noisome, it took a week to clean the smell from the detached crowns and a month for my gum to appear healed with medication. I am afraid of having the crown reattached and would like to have the implant removed. Is this possible?

    Reply
    • I have a specific post about removing dental implants.

      That being said, I think it safe to recement it. Just be sure to use a very tiny bit of cement and to make sure the margin of the abutment is customized in a way that the dentist can clean it out. An x-ray should be taken immediately after the crown is cemented to make sure all the cement is taken out. Cementing and implant crown is quite different than cementing a regular crown. You would think it is very simple but there is actually a lot to it. I would suggest you see somebody who does a lot of implant crowns

      Reply
  5. I am at a loss for what to do right now, I am 29. I got swindled into a root canal two years ago that was the worst experience of my life. Went to an endodontist specialist for the treatment. Now I hate any dental procedure, even cleanings, and have severe anxiety and panic around all of it. The root canal has failed and the tooth is infected. It is tooth #30, new endodontist told me there is nothing they can do and it needs to be extracted. The only option the dentists will give me is an implant but I am terrified and my insurance will not cover anything. My savings were already ruined after the root canal, which I can’t get back even though it failed, and now I can’t stomach the thought of paying again for something even more expensive. I am tempted to just get it extracted and leave the hole, would this decision be as terrible as these dentists are trying to make me believe? I do not want to pay my entire savings for something that fails or that I don’t need.

    Reply
  6. 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.

    Reply
    • 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/

      Reply
  7. 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.

    Reply
    • 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/

      Reply
  8. 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

    Reply
  9. 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

    Reply
  10. 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!

    Reply
  11. 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!

    Reply
  12. 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.

    Reply
  13. 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.

    Reply
  14. 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.

    Reply
    • 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

      Reply
  15. 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.

    Reply
    • 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

      Reply
  16. 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.

    Reply
  17. 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.

    Reply

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