The goal of endodontic treatment is to save the natural tooth for a lifetime. However, there are instances in which a dentist or specialist may decide that a tooth cannot be saved and, therefore, render it “non-restorable.” These teeth may also be called “non-retainable” because they cannot be retained in the mouth for any significant, predictable period of time.
Here are a few reasons why a tooth may be considered non-restorable:
- Extensive decay or destruction of the natural tooth structure—this scenario prevents a dentist from adequately restoring the tooth, leaving it susceptible to further decay, pain, and possible infection.
- Advanced periodontal issues—if periodontal issues are not controlled, this predisposes the teeth to recession, bone loss, and eventual loss of the tooth.
- Resorption is a dental process that occurs when the cells that surround the tooth begin to eat away at it, which is is typically due to some form of trauma.
- Iatrogenic causes can occur; these are typically induced inadvertently by a medical or dental professional during treatment or diagnosis. For example; some teeth can have root canal systems that are very calcified or small, and during the search for these, a hole (or “perforation”) can be created by the dental drill or instruments. If these perforations are not addressed and repaired in a timely fashion, or if the size of the perforation is too large to repair, the overall health of the tooth will be compromised in the long run.
- A crown-to-root ratio that is less than one to one is not ideal. In other words, the remaining tooth that is encapsulated in bone should be at least the same amount that is outside the bone. Torqueing forces that are exerted on the tooth are an unstable environment for any tooth, especially one that is already compromised.
- Certain types of trauma can lead to early tooth loss. For instance, if a tooth is avulsed, or “knocked out,” and is not put back into the socket within one hour (depending on stage of root development), the overall prognosis for retaining that tooth is poor, and the tooth will eventually be non-retainable.
- Vertical root fractures will inevitably doom a tooth to failure. A root that has a fracture extending vertically, especially if it communicates with the oral cavity, has a hopeless prognosis and is considered non-retainable.
Like with any dental procedure, it is the obligation of the treating dental professional to present his or her patient with dental treatment options, along with the likelihood of success associated with those options. Our duty as endodontists is to provide our patients with all of the necessary information about their oral health, their treatment, and the projected outcomes of those treatments so that they can make an informed decision that is best for them.