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sujatabyahatti's picture
Joined: 19 Dec 2010

In the scientific and clinical community, it is common knowledge that endodontics has evolved from the dark ages similar to the way implantology did.Implants enjoy success rates similar to well-selected endodontically treated teeth, and endodontists evolving to include both disciplines are evidence of that change.

It was once thought that root canal treatment was an arduous procedure with uncertain results. Implant dentistry has undergone comparable scrutiny and it has also emerged. Sometimes, for the disciplines of endodontics and implantology, the success rates are underestimated or overestimated; and/or the procedures are not respected due to poor choices by clinicians, or because of a rivalry toward the opposite discipline. Perhaps some clinicians may choose to treat compromised teeth, or choose to endodontically treat a difficult case, realizing later the disservice to the patient and the harm to their own long-term success. In comparison, placing implants, with no regard for advancing one's training prior to doing so, can be similarly deleterious. A conflict of interest may also exist whereby those who never received adequate training in one discipline, or those who have a vested interest in a service that they offer, might be reluctant to offer the diametrically opposed discipline. These examples demonstrate why reputations of a procedure, or discipline, can become tainted.
On the other hand, some practitioners consider the single tooth implant a reasonable alternative to the preservation of a diseased tooth. However, the practitioner should be better prepared to determine which treatment option is most appropriate for each individual patient.Furthermore, the debatable concern of defining what constitutes the standard of care, by offering a tooth-supported fixed partial denture as compared to a single-tooth implant, has created alarm.
In the early days, replacement of already missing teeth dominated the practice of dentistry, whereas today, patients present for treatment to replace teeth that first need to be extracted before implants can be placed.This has led to another heated issue: removing a structurally sound tooth for substitution by implantation. The debate continues, and slowly the adversarial contention of implant versus endodontics has sensibly given way to implant or endodontics.In the future, treatment options may evolve to include endodontics, implant therapy, or genetic reproduction.
Implant dentistry and endodontics have steadily undergone paradigm shifts whereby trust and respect are still being established in the dentist's and the public's eye. Due to some similarities occurring with the evolution of each discipline (as financial gains are realized by both the manufacturers and clinicians), more dentists are driven to perform endodontic treatment or place implants. Some dentists seek proper training while others do not, and implantology may undergo criticism (similar to root canal treatment) as poor outcomes and/or undesirable results mount. As more clinicians enter the implant realm without reasonable and proper implant training, one might expect that this may blemish the image which implant dentistry (similar to endodontics) has strived to achieve.

Although research is lacking, a reasonable and seasoned endodontist would not disagree on factors that can diminish success. Some factors could include poor skill set, failing to use microscopy, failing to use orifice barriers such as portland cement (MTA), and failing to defer on treating teeth with poor ferrule or deep axial/pulpal floor/or even suborifice root fractures, which yielded a failed outcome. It is accepted as common knowledge that microleakage, fractured teeth, endo/perio issues, and poor clinical crown volumes have never reflected well on endodontic or restorative success rates. Based on extensive experience, it is this author's opinion that combining nonsurgical treatment with surgical treatment more often (during the same clinical visit), does indeed improve endodontic success; and yet, not implementing this approach for more cases undergoing nonsurgical endodontic therapy occurs. When these aforementioned concerns are not considered, the image of endodontics becomes tainted as failures occur. Similarly, implantology has undergone a comparable evolution in materials and techniques. It was once thought that implants did not work or that the procedure was risky. Comparing endodontics and implant dentistry, the consequence(s) of failure due to improper training or experience is tangible.
In order to preserve the success rates that can be achieved with implant dentistry, the clinician must understand more about the sales and marketing pressures involved. For example, dentists must recognize the pressure of sales and marketing as seen in the implant representative's tantalizing offer to sell an implant start-up package at an abbreviated continuing education course given without due diligence and a solid learning experience. It is imperative that any clinician incorporating implant dentistry into his or her practice understand the principles of implant care so that all the potential risks are understood.
Currently, it is apparent after reviewing—what others opine, various scrutinizations, and the purported editorials and claims thereof—that a contest exists between endodontics and implant dentistry. Also, based on varying parameters, that one procedure is (perhaps) always better than the other. Along these lines, a form of ostracization exists whereby endodontists might be looked upon by peers with peculiarity, or even be investigated by their respective state dental board if they choose to place implants because of arbitrary opinions or a disregard of differences. Some peers may think that an endodontist should not be part of, or included in, the implant treatment team; or that we are not welcome at continuing education courses or other relevant programs with open arms. This has caused a great stir amongst varying parties from a variety of entities with vested interests. The definition of the scope of practice of endodontics and the accreditation standards clearly indicates that participation of endodontists in implant dentistry is warranted and ethical, contrary to what some may believe.
In light of these political concerns, and more importantly the clinician's dilemma with a patient's clinical issue, it is not always possible to predictably save teeth with periodontal treatment or endodontic treatment, and other options need to be made available. In fact, periodontic and endodontic/implant algorithms have been proposed to help understand if saving the tooth or replacement with an implant is a better option.


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