Dental implants vs. root canal therapy
November 16, 2015
— Implants or endodontics treatment — is one better? This was the hot button issue tackled during Myths and Realities: Dental Implants vs. Root Canal Therapy.
The popular presentation at ADA 2015 featured experts from various dental disciplines who each shared views on the long-term survival and cost-effectiveness of root canal therapy, dental implants and alternative treatment. The 90-minute course was presented Nov. 7 before a capacity crowd at the Marriott Marquis.
“What is the case history, is it restorable?” asked Dr. David Little, the panel’s general dentist, as he walked the audience through his approach. Dr. Little, who also teaches at the University of Texas Health Science Center at San Antonio Dental School, recommended getting the entire team involved from the dentist to the surgeon to the technician to the patient.
Rounding out the expert panel were:
Dr. Stuart Lieblich, oral and maxillofacial surgeon and clinical professor at the University of Connecticut.
Dr. Jaime Lozada, professor and director of the Advanced Education Program in Implant Dentistry at Loma Linda University.
Dr. Alan Gluskin, professor and co-chair of the department of endodontics at the University of the Pacific.
Dr. George Duello, periodontist from St. Louis.
The course, presented in partnership with The Journal of the American Dental Association and the Council on ADA Sessions, was moderated by Dr. Daniel Meyer, an endodontist and the ADA chief science officer, and Dr. Michael Glick, professor in oral medicine and William M. Feagans Chair, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, New York; JADA editor.
“Making comparisons is just not fair,” said Dr. Lozada, who along with all the panelists agreed that the first approach is to “save the tooth.” Dr. Lozada, a past president of the American Academy of Implant Dentistry and editorial board member of the Journal of Oral Implantology, also discussed some of the clinical challenges of implants including bone maintenance and what to do if the implant is not grafted.
Dr. Duello stressed ethics during his presentation and urged the audience to consider “pathways to care.” He said when determining whether to do an implant on patients, he first assesses the ethics — the medical and social context, and then looks at the evidence and consults clinical practice guidelines.
“What is the standard of care?” said Dr. Duello.
Dr. Gluskin’s talk touched on endodontic failures, vertical root fractures and excessive post placement.
“We need to think about the longevity of endodontic treatment,” said Dr. Gluskin, who also considers dentin strength and age when deciding on treatment options. “This is our issue. We need to know how to restore it better.”
For his presentation, Dr. Lieblich shared a retrospective analysis of the last 100 teeth that were referred to his practice for extractions. After eliminating third molar and orthodontic extraction cases, he found that 41 percent of the teeth had previous endodontic procedures, with an additional 9 percent referred by an endodontist after it was determined a fracture existed. Although not an indictment of endodontics, he said it “does reflect that the endodontically treated tooth may have a higher long-term failure rate” and “even successful endodontic treatments can ultimately fail.” It should also be noted that as an oral surgeon, Dr. Lieblich regularly sees failed teeth and implant cases.
During the questions and answers session, Dr. Brian Jafine, an endodontist from Willowdale, Canada, noted the importance of patients following good oral hygiene practices in maintaining their restorations following treatment.
“[We need to consider] what caused the problem in the first place,” Dr. Jafine said.
Though it was clear both root canal therapy and dental implants have high 5-year success rates, Dr. T. Bob Davis of Dallas said that well-designed, long-term (10- to 15-year) clinical studies are needed before any conclusions can be made about the success rate of restored implants.
In a crowd that included a large number of general dentists, Dr. Meyer asked each of the panelists to share the most important advice they could give.
“Be involved,” said Dr. Lozada, who recommended training.
Dr. Lieblich agreed, adding that he encourages general practitioners to find mentors and observe and share cases.
“Can the tooth be restored?” stressed Dr. Gluskin.
“Know your patient,” said Dr. Little.
Following the Q &A, Dr. Glick posed a question of his own, perhaps foreshadowing an idea for next year’s course: “Who’s going to place the implant? Or, maybe the better question is: As it is not always possible to discern what may cause a possible failure, the implant or the restoration, who is responsible?”