Anıl Çetin

I hear this question almost every week, and my answer always starts the same way: let us look at the tooth first. A natural tooth that can be saved is not exactly matched by anything put in its place, in the relationship it has with the surrounding tissues or in how chewing feels. So I always begin the assessment from the possibility of keeping the tooth.

On the other hand, this does not mean every tooth must be saved under every circumstance. The amount of sound tissue remaining, the condition of the root, whether a sound restoration can be built on the tooth, and the patient's overall oral health have to be weighed together. In some situations an extraction, and the treatment planned to follow it, serves the patient better than insisting on a root canal.

In other words, the question has no general answer; it has an answer for your tooth. At the examination we talk openly through the advantages and the limits of both options for that particular tooth, and we make the decision together.

The phrase 'dead tooth' creates an unfair despair in patients. In root canal treatment the vessels and nerve tissue inside the tooth are removed, that much is true; but the tooth keeps its relationship with the bone and supporting tissues around it and goes on doing its chewing work. What remains is not a structure that has lost its function, but a tooth cleared of infection and taken under protection.

One of the most important factors deciding the life of a root-treated tooth is the quality of the restoration built on top of it, and the patient's oral care. Properly restored and regularly checked, root-treated teeth can be used without trouble for many years. This is exactly what has interested me since my doctoral years: root canal treatment is not the end of a tooth, it is the beginning of the effort to keep it.

One of our patients had booked the appointment for an extraction. The decision was already made as they sat down; they had suffered enough from this tooth and wanted to be rid of it. After the examination and the X-ray the picture looked different to me: the tooth had enough sound structure to be worth trying to save, and the source of the complaints looked treatable.

I did not press them; I described what I saw. We talked it through point by point: extraction was on the table too, but why trying root canal treatment first was reasonable, and how the process would go. They thought for a while and then said that if I was giving the tooth a chance, they would give it one as well.

We completed the treatment and the restoration on top of it. That tooth is still in place today, and we still see each other at the yearly check-ups. The reason I value this case is not the outcome but the process: whatever decision the patient arrives with, the clinician has to describe honestly what they see, and leave the last word with the patient.