Tooth infection: surgery or implant?

For some time now I have a tooth infection in one of my back tooth. The problem is that the root canal treatment was not carried out properly and now more than 10 years later the residual root is infected:

Now I will have two options:

a) removing the root from the outside. For this the cheek will be opened surgically and then the doc has to drill into the jaw-bone to reach and remove the root. The good news is that this will preserve the tooth. The bad thing is that this will remove parts of the jaw-bone that might be important for an implant that might be necessary later in life. This procedure will be fully covered by the health insurance.

b) removing the tooth and replacing it with an implant. The good news is that this will be a good long term solution for a tooth that is already dead. The bad news is that this will cost around 2000 EUR because it is not covered.

How would you decide? Your tipps and insights are highly appreciated.

Update: the option a) was possible without opening the cheek. Everything went well and pain wise it was okay. Both roots have been removed and both got a filling. I am just glad that I could keep my tooth.

Interesting. I had exactly the SAME problem last week. I HAVE no insurance here in the USA so I had to have the tooth pulled. now I have a hole in my mouth…oh, wel…there is nothing there now to get infected. I would have loved to have an implant…but way too expensive. The infection is hard to get rid of…so don;t leave it too long. The PAIN was excruiating for me.

wow, that removing the root from the outside sounds like quite a procedure!

I did have a molar removed two years ago. It was loose and infected and hurt very much, like Sheila’s. I had to wait for about 6 months to start getting the implant. I got the first part (it looks like a miniature manhole cover that they attach the tooth to), which was pretty unpleasant, and then waited a few more months to get the tooth. It was very expensive, I think around $5000 for the whole thing. I just love it, and it feels great! I’m going to have to go through the same thing on the other side of my mouth eventually. My solution right now is I don’t eat on my right side. I’m so sorry you have to make this decision, Holger.

Decisions in the face of uncertainty. Let me just ask you right now. The tooth is dead, would you have an implant right now as a replacement? Some of the decision has to do with whether it matters.

If I lost a front tooth, implant is pretty clear. But a side tooth, one that is minimally needed for chewing, you could get aways just get bridge. I’d have to think about that.

@Sheila: I have read your story too but at that time I had the hope that the problem would magically disappear. I can not afford to have two health problems, LOL.

@Marry: I am pleased to hear that you love your implant. In my mind I tend to the implant solution too but I will wait for the consultation with the surgeon to make a final decision. With the current dollar exchange rate the US price looks pretty scary (at least the prices of German products will look less scary now ;-).

@bsc: I asked my dentist what solution he would prefer if put in my shoes (my standard question for professionals). He did not suggest the bridge because of the good condition of the other teeths. Actually the bridge is the only solution my dentists could produce himself. For the other solutions he will send me to colleagues. I think this speaks for his professionalism.

I’ve had botched root canals twice and after much expense and pain, had each tooth pulled. The dentist said, “well, we could try some surgery and remove the root” and I guess it was the word “try” that made me say forget it. Each tooth was a middle molar and implants were still in the experimental stage, so I had to get a bridge on each side - a fake tooth where the missing one is, anchored to the two good teech on either side.
But the money thing is a significant factor. I guess if there were any way that you could afford it, I vote for extraction and implant. And yes, I agree that the bridge does compromise the integrity of the two other good teeth. Luckly I’ve had no problems with mine. But I recall that they were quite expensive too.

This 80 year old type 2 has been doing the implant route after breaking a front incisor at the root. So far, the only discomfort has been writing the check. The podiatrist trimming my toenails has hurt me more and that not very much. Tomorrow I go in to get the implant exposed at the working end and prepared for a crown installation, So far the effort has been painfree and without incident. With two titanium hips and eye lens replacements, a tooth implant looks like a normal progression. Good luck.

Holger, what became of your tooth infection ; what procedure did you choose ??

@Nel: my surgeon thinks that he can reach the root without opening the cheek. The small operation will be tomorrow.