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Letters: Another perspective

January 18, 2016 Jennifer Garvin’s report from the 2015 ADA meeting (“Dental Implants vs. Root Canal Therapy,” Dec. 7, 2015, ADA News) does not mention an important difference between implants and endodontically treated teeth: proprioception. After reading the article, I’d like to bring up an additional perspective.

Dental implants have no periodontal ligament, and thus no proprioceptive activity, but that’s seldom an issue when patients still have remaining natural teeth. The periodontal ligament around tooth roots contains sensory pressure receptors, which provide proprioceptive input to the brain while chewing, helping to guide jaw movements. These pressure receptors remain vital after endodontic treatment.

Completely edentulous patients have zero periodontal proprioception. When such patients are restored with upper and lower implant-supported bridges, it is common for the porcelain teeth to eventually chip. When that happens, the lack of proprioception is often blamed. There is no quick or easy way to repair broken porcelain, especially longspan bridges.

Patients who contemplate having their last teeth removed to make room for implants should be informed about the advantages of retaining some periodontal proprioception, especially when porcelain bridgework is desired. From the standpoint of proprioception, even one retained endo-treated abutment seems better than none. Unless aware of all pertinent facts, a patient cannot make an informed decision nor give informed consent.1

Robert B. Stevenson, D.D.S.
Columbus, Ohio

1. Rule JT, Veatch RM. Ethical questions in dentistry 2nd Ed. Hanover Park, IL: Quintessence Publishing; 2004: 304.