Implants Impacting Endodontics?

Steven asks us:
I am going into my fourth year of dental school and am trying to figure out what direction to go after I graduate. My family dentist encouraged me to go into a specialty and he recommended endodontics.

I have completed one research project in endo which I hope to publish. But I wonder if endo is going to draw down because of the number of dental implants that are being placed. In fact, I have heard that that many patients are opting for dental implants instead of endo. Interestingly, I even recently saw an advertisement for a dental implant placement course Nobel Biocare is giving specifically for endodontists. So, my question is: should I apply for endo? With the growth in the dental implant market, will there even be enough endo for me to make a living? Is the future of endo in dental implants?

40 thoughts on “Implants Impacting Endodontics?

  1. If you love endo go into endo. There will always be a need for endo. To say that every tooth that requires endo should come out and get replaced by an implant as a blanket treatment is a disgrace.I’m a gp I place implants and I do my own endo. Neither one knocks the other out of the ballpark.Sometimes the implant would be the prudent choice. Most of the time I try to save the teeth if they’re in good condition otherwise. Besides, what about retreatments.? If anything apicos should be a thing of the past. If you are a crackerjack endodontist you’ll find that you could get referrals for the retreat instead of subjecting the pt. to the apico crap shoot.Do what you love,success will follow.

  2. There are many cases that implants are chosen over endo in the difficult retreat, the patient who has had endo failure and/or crown/bridge failure, etc. How far this trend would go in the immediate future to affect your career is unknown. There are endodontists who are concerned and want to get into implants, just as periodontists did to turn around their specialty. I would agree with Dr. Mosery to do what you love.

  3. So long as gp’s are doing crown and bridge, there will always be a need for endo. When a patient has just spent over $1000 for that new crown and the pulp goes, are we going to advise our patient’s to pull these teeth and get an implant and a new crown? Of course not. The majority of cases you will see as an endodontist have some sort of prosthesis fixed to them. So I say, go for endo, if you love it. And if endodontist’s start placing implants, hoorah! They’re the one’s that technically should be placing them anyhow. This paradigm shift is just an illusion. Natural teeth will always be saved; we practice dentistry remember.

  4. Marry a person you love or a person look having good future. There is no correct answer in life. Decide now and feel the result of your decision later.

  5. I agree with with above comments, there will always be a need for endo, but there is already definite paradigm shift away from the “herodontics” that we’ve all practiced in the past. I vary rarely perform or recommend the “endo retreat, hemisection, post & core, new crown” route anymore. Implants are far more predictable and in the long run will cost the patient less. But there will always be a need for endodontists and I have yet to see one starving. So if you enjoy it, do it.

    To Dr. Zerella: I was just wondering why you think that endodontists “technically should be placing them anyhow.” Nothing against endodontists at all I think they’re great, but the ones I know generally don’t like surgery, haven’t extracted a tooth since dental school, have never done a bone graft, sinus lift, ridge augmentation, or a block graft nor do they work with occlusion on a regular basis. This is not to say that they aren’t perfectly capable of learning how to do it, but wouldn’t a surgeon (perio or OMS) or a GP with surgical experience be a more qualified individual to place implants?

  6. The endodontist to whom I refer also places implants. Although I perform endodontics and place implants as well, when I refer a difficult case I expect my endodontist to provide the best option to our mutual patient. Because he can provide either treatment, I know the patient will receive the most appropriate care. I value this service as do my patients. As an aspiring endodontist you should be sure to master implant placements as well as endodontics and offer this as a beneficial characteristic of your practice.

  7. The honest and ethical dentist will do what is best for the patient, not his or her bottom line. There will always be a need for both forms of treatment especially when outcome assessment studies are performed properly and fully understood by the profession.

  8. There is no doubt that Implant dentistry has changed the practice of endo as well as perio.
    As far as periodontists are concerned many are more intersted in extracting the questionable teeth and replacing them with implants rather doing hard core perio to save them.
    May be it is economically more rewarding.
    But as far endo is concerned still there will be enough endos to be done,
    because
    1,some patients may wants to save their own natural teeth.
    2,some patients still may count the difference in fees between endo and implant.
    3,many dental insurances do pay for endo but not for implants.
    4,some patients may not be fit medically for implants or major grafting procedures.
    5,some patients may be just afraid of those surgeries.
    6,there are more stories floating around among patients about complications from implant and grafting surgeries than from endo.
    7,time difference between finishing endo restoration and implant rstoration may be an obstacle to some for implants.
    8,extra need and expense for provisionals may be deterrent to some.
    In my opiniion if endos are being done efficiently and carefully success rate of endos is more or less equal to implants.
    But if tooth requires endo,post,crown and crown lengthening, implant should be considred.
    If tooth also needs apico,just go ahead with implant.
    as long as resin restorations are being placed by less trained clinicians,there will be plenty endos in near future,
    I can not say for your life.
    Endo is a very good branch, you will have succeess.
    But in worst scenerio you still can learn implant dentistry and start placing imnplants.
    Why are you worrying now?
    As matter of fact I have friend,who after finishing endo joined 2 years fellowship in implants and practices both now.

  9. Two very quick points. I am a General Dentist. I graduated in the top of my class of the number one ranked school in the nation and could have gone to any “specialty” I wanted to. But I did not want to limit my practice. I have been doing endo for ten years now. I would put my treatment against any endodontist in the country. I feel that anyone doing this type of treatment should feel the same or stop doing it. I also feel good about most dentists trained with in the United States. I have no personal knowledge of the level of training a foreign dentist recieves, so we are comparing apples to oranges most of the time here. I also have been placing implants for the same length of time. Both areas of treatment have done well. I don’t cut one for the success of the other. For the most part they have different indications. And as far as the “as long as gp’s are doing crown and bridge”, I have re-treated endo done by you guest it, an endodontist. Everyone is at risk of having bad results don’t fool yourself.

  10. As a clinician who has performed endodontics and implant dentistry for over twenty years,I can honestly say that the availability of implants has NOT impacted the number of endodontic cases I do. In fact, implant dentistry serves as an adjunct to the services we provide. Vertical fractures, and poor cinical crown volumes have never reflected well in our success rates for long term retention of teeth. We give the patient a choice backed up with our experience performing both modalities. Most often, patients are choosing the implant option to treat very marginal cases. But we would never routinely sacrifice a viable tooth just to perform an implant procedure. If you choose endodontics, rest assured that you have a very promising future. If you plan on adding implant services, just remember it is a RESTORATIVE discipline first. If you are not willing to get training in prosthetic principles (whether or not you will ultimately restore the case), perhaps you should stick to your specialty.

  11. First of all, do what you love. Secondly, most endodontists I know hang a shingle and have instant patient flow.

    True, I believe more and more patients ARE opting for implants as opposed to conventional endo. Nevertheless, even though endo does have it’s pitfalls, there will always be a place for conventional treatment in the future.

  12. The Society of Endodontists published a position paper stating the belief that Implant placement needs to become a part of the Endo practice. More and More GP’s are doing Endo and Perio in house on many cases that should be referred out. In Perio, anti-microbial treatment from the GP’s hygiene team has eliminated moderate perio case referrals. The added revenue from placement of these products does not hold up to the benefit the patient recieves. Most patients with a 7mm or deeper pocket need to be flapped. Laser companies are marketing to GP’s with the CPT book and doing weekend courses on both Endo and Perio applications. Nobel, the most aggressive company with this push, has a mentoring program to teach GP’s how to place implants. Usually led by a specialists former referral. Endo is being pushed at the edges because dentistry does not limit what the General Dentist is allowed to do with Patient Care unlike the medical profession. Do what you like but going in you should know that industry is trying to get more patients in implants through GP placement and pushing GP’s to do their own Endo.

  13. I agree with Satish Joshi.
    Speaking from personal experience, root canal is much safter than implant. I’ve had three root canals both have crowns that are 25 years old. Never any problems whatsoever. Unfortunately, I was dooped into a dental implant that turned out to be a nightmare. In pain 24/7, grafts, surgeries, exraction resulting in severe bone loss. and of course, my insurance would not pay for implant related health problems. Root canals, however, are almost covered in full. I do not believe implants are having an impact on root canals. If they are, it will be temporary as we begin to see more and more implant complicatons.

  14. As a profession we may place to low a value for tooth substance. We may be preparing too many teeth for full coverage and not considering other options consistant with the conservation of the bulk of the natural tooth at the cervical region. In addition, teeth are in a powerful sense sensory end organs which provide valued feedback to mandibular physiology as well as maintain the alveolar housing.
    Honest disclosure to the patients regarding outcome assessment of whether to restore or extract for a better prognosis is essential. The patient must be party to the decision process. Things for us to consider when restorative antics are selected is the load capacity, or the ability of the tooth after endo, post core and crown lenghting and further reduction at the cervical for the ferrule will weaken the tooth perhaps even more. Where is the tooth in the arch? Cuspids and molars will take on more deformation under load and are functionally more at risk. The overall host reststance and the health of the patient as far as grafting and surgical placement, these and many other factors must be considered.

    If you want endo go for it. The services that can be provided for our patients is wonderful

  15. According to the AO: “A recent systematic review comparing the two most common treatment options — root canals and dental implants — found virtually equal success, or survival rates, between both treatments. However, despite this similarity, the authors conclude that the priority should always be to preserve the natural tooth before extracting and replacing with an implant.”

    Thoughts on this position statement?

  16. I think endo is dentistry’s dirty little secret. The best root canal that has ever been done in all the world leaves at least 40% necrotic material behind. This material seeps into the blood stream at some point. Think total body and think about the heart. Bacteria found in gum pockets has been isolated in the endothelial lining of arteries. I no longer reccommend rct treatment in molar regions. And am moving furthe anteriorly with implant reccommendation as time goes on. Holding onto rct teeth usually makes implant placement more difficult and subjects patients to unecessary bacterial attack. Would you want necrotic material leaking into your blood stream for years and years? It is called a chronic infection. Root canals are tolerated by the body implants are accepted.

  17. A bacterium associated with an asymptotic endodontically treated tooth complicates the diagnosis and treatment planning of an already challenging field of implant dentistry. The classic studies of Brynolf pointed out that the lack of radiographic evidence dose not preclude inflammation at the apex of endodontically treated teeth. She when on to say that 93% of root canal treated teeth examined in cadavers had histological signs of inflammation. Green et al. characterized Bryolf’s studies as questionable because of differences both in treatment techniques and methods of radiographic and histological analysis at the time. She reported only 26% of a very small sample of 26 teeth studied had normal appearing radiographic appearance with histological sign of inflammation. She reported that the vast majority (75%), which had a normal radiographic appearance, also did not have histological signs of inflammation. It is noted from her results that 10 of the 29 teeth (34%) of the histologically examined specimens had radiographic evidence and also showed an inflammatory cell infiltration surrounding the apical foramen. Of the remaining 19 teeth, 5 had histological evident of infection without any radiographic evidence. Analyzing the data differently from the viewpoint reported by Green, of the 29 teeth examined, 15 total teeth examined had an alarming 52% histological evidence of inflammation, presumably associated with bacteria.

    Taking into account the reported cases of implant failure next to endodontically treated teeth together with the large percentage of periapical lesions reported on endodontically treated teeth in cadavers, the combination of the evidence has problematic consequences to implant dentistry, but unimaginable implications to dentistry as a whole when considering the liability that might attributed to dental clinicians because of recent findings relating dental infection to atherosclerotic heart disease and other systemic problems.

  18. TO Jeffrey R Singer DDS
    YOUR COMMENT IS NOT OBJECTIVE, DO BETTER RCT AND SEND MORE SERIOUS MAIL
    ELIE DDS

  19. i have read many great comments and enjoy reading the osseonews.

    here are my 2 cents

    a balanced aproach is the best way. in the past while implant therapy was not reliable, making all efforts to save a tooth was reasonable. with the success rates of modern implants hovering well over 90% it may not make sense to do heroics such as apicos which according to the endo literature have a success rate far below 90% more like 50-60%(got that at an endo conference for endodontists) and in many cases the apico defect created does not fill in with bone but granulates in. the bone lost during an apico procedure could be better put to use in supporting an implant.

    traditionally (and some periodontists do this even today) mobile teeth were nursed for a long time. it may not make sense to “keep” a tooth that has class 2-3 mobility due to perio because more bone is lost and to place an implant will require more additional procedures and materials(grafting)

    as far as the specialists are involved we might consider that historically most procedures were done by GPs. that includes endo, implants, etc. when the branemark implant system became comercially available one could not buy the system and just start placing implants. whether GP of specialist there was training by the company with strict guidelines on placement and restoration.

    at this time oral surgeons, periodontists, prothodontists, GPs, and endodontists are placing implants. the best sources have it that implantology will not become a recognized specialty any time soon. clearly solid training is important whether you are a GP or a specialist. even in medicine there is cross over between specialties. raiologists doubling up and moonlighting as emergency docs, etc.

    the market is changing some but there is room for everyone. all the best in your quest.

  20. The success rate of endodontic surgery, performed with surgical microscope, ultrasonic tips and so on, is reported over 90% in the last peer-reviewed articles. (Maddalone & Gagliani 2003, Taschieri et al.2005, Tsesis et al. 2006,…..) 50-60% was the success rate reported in the past.

  21. I was in a lecture at the CDA, talking about implants vs endo and especially endo re-treatment. The idea presented in the lecture was that with endo re-treatment, a better option might be doing an implant.

    The other thing that they talked about was managing the expectations of the patients in terms of esthetics, expected lifespan of the restoration, etc.

    What do you guys think about these two ideas or theories?

  22. What is best for the pacient? Dr. do no harm. Is there enough bone supporting the tooth which may require root canal? are the canals negotiable? Is the tooth asymtomatic? Is the tooth restorable? Some hemisections are the size of 3.5mm implant. Yes oral rehabilitation function and esthetics or as impantologists prosthetics dictates implant placements. I would like to know if you can sample the blood or put a doppler on the heart if you could detect strep viridans? How significant is the microleakage in this supposeable steriale inviroment? Also there is periimplantitis, crestal bone loss, screw fractures, time and money.

  23. I do endo and place implants as well. As a general dentist, we had excellent endo training in Mississippi. The endo department was one of the best. when I took the AAID Maxicourse, our research subject issue was endo vs. implant. The core statistics (all Pubmed reviewed literature) places the longevity of implants over endo at the ten year mark hands down with more endo failures from nonrestored teeth following endo or abutments for bridges. These are all peer reviewed articles. BUT, That does NOT mean we as dentists have to take out every tooth that needs endo. That is ludricrous and in my view malpractice – and it wouldnt hold up in any court anywhere in the country (The poster who removes the molars, my advice is for you to think twice about what you are suggesting – I dont think this community is with you on your mindset and the courts wont be either). Ill go for the endo always first – with some benchmarks on the decision tree. The UAB prosthodontics department is teaching that if the tooth can reasonably be expected to last > 5 years, do the endo. If not, do the implant. You have to look at multiple factors – Patient, age, bone, soft tissue, tooth function, parafunctional habits, hygiene, other oral conditions, finances, whether or not orthodontics is a possibility, etc. Its not just a “one vs the other” deal. That is how I consult with the patient. Talk about it all and then come to a conclusion. As far as the poster who mentioned that we all have failures, thank you. Thats an honest assessment. All treatment isnt sucessful – no matter how good or not it looks on a PA. Some of my worst appearing RCTs are 24+ years old now, and some of my best ones appearing on a PA that I would have been proud to show to the endo department that taught me have failed. So there you go. Thats the practice of dentistry. Its ongoing and evolving always. Nothing is truly static in health care. Hope that helps some. Endo will always be a good specialty. Bill

  24. It’s very interesting to note that everybody wants to place implants….until a serious complication arises and then they call the OMS for help!!! Well, do what you like and you’ll be successful. But remember: years of appropriate training give quality work to our patients, and not some “weekend courses”.

  25. Surely OMSjaw, that is why you are a specialist, to look after the difficult cases and the serious complications. If you can’t do that then why are you an OMS?
    As to the OMS training, there is no question that the training in removing ameloblastomas,repairing jaw fractures,performing orthognathic surgery and many other surgical problems of the head and neck are well taught, but the facts are that training in implant placement, which by the way is not just a surgical discipline but requires a broad understanding of all the disciplines of dentistry,has not been a significant part of an OMS training, and well trained general dentists are probably much better suited to implant placement because of their broadly based experience and knowledge.
    Certainly when I commenced implant dentistry over 30 years ago, there was no formal training anywhere in implantology,let alone in a OMS training program.I’m interested in learning about the years of appropriate traing you have received and how it differs from the training that well trained GP’s receive in implant placement.

  26. Omsjaw,
    Oral surgeons always use that point when the subject of anyone placing an implant other than OMFS arises. The fact is that OMFS refer to other more specialized OMFS’s or physicians when they encounter a complication they can’t handle. So that argument doesn’t have much validity, unless you are an OMFS that never refers out anything. It boils down to proper training no matter what area of dentistry you practice. During my fellowship I had to assist an OMFS at the local hospital and he managed cases that other dentists INCLUDING OMFS’s referred to him because they were beyond their training or were not able to manage the complication. Yes, OMFS’s sent him complications they could not manage. This is done in medicine as well. Just because someone is placing implants does not mean they took a weekend course.

  27. I think endo and implants can be “friends”. They can be “more than friends”. I’m working in a team project where we are making endodontic therapy as a bone generator vector. The idea is to make endodontic treatment and obturate it with proactive substances, disinfect and gain bone through the root cannal and THEN do the extractionn and the implant. Excellent results, very simple and more predictable from an osseus point of view. For those who want more information about it, you can contact me and I’ll give it with enthusiasm. Thanks and hugs for everyone at the blog.

  28. Hey Dr. Singer-

    It’s because of dentists like you that implants are becoming so popular. No molar RCT??? You’re doing a huge dis-service to your patients You obviously don’t know how successful endo treatment is. Read the literature and you’ll see that your statements are garbage. 40% Necrotic material??? Whatever!

  29. Wow, I am amazed at what some people are saying. I am an oral and maxillofacial surgeon (OMS), I trained for years placing implants, placing bone grafts as procured from the skull/chin/leg/hip, sinus lifting, ridge splitting. I have seen the complications and they can be anything from inconveniencing to downright miserable to the dentist and patient. I have to say experience does hold a lot of water to anything else. To say someone shouldn’t place an implant because they don’t have the credentials is foolish. If they’ve successfully been placing implants for years with proven success so be it.

    I think the problem arises when one attempts to go beyond their level of comfort. For example, in our GPR program here many of the residents are still fearful of laying a small flap during an extraction. If that’s the case then how the heck can you feel comfortable placing endosseous implants? That’s like saying you’re comfortable doing a full mouth extraction but not with doing the alveoloplasty. When contemplating implant placement you have to remember that, just as the root of a tooth can snap in half when taking it out; so can the implant perforate the buccal bone during placement or perforate the sinus, or hit the mandibular artery. These are just the obvious complications.

    By the way, as much as I am in favor of implants and their associated wonderful success rates, I think retaining natural teeth can be one of the best services to offer. To suggest that endo’ing a tooth leaves infection to percolate through the bloodstream ad infinatum is one of the dumbest things I have ever heard. Since when does the apex of an RCT’d tooth have a direct connection with the bloodstream? I guess if transient bacteremia were so deleterious we should all be dead by now. Even people with near-death neutropenia still stay healthy when they have bowel movements through hemorrhoids or floss and bleed. And don’t even get me started on this whole heart disease and periodontal disease hypothesis! Anybody who recalls who Koch was will remember his postulates and I’m damned if I can think on even one of his postulates that would be satisfied by the periodontal disease-heart disease connection. But I digress. Back to “Dr” no-endo… I can only imagine the conversations this guy has with his patients. I don’t care if this is harsh-sounding, I have no respect for people who talk absolute hogwash in a professional capacity. You want to philosophize? Save it for the locker room or the cigar bar or if that’s not good enough go into the tea leaf business. I have some toads and newts in the yard for you.

    What happened to evidence-based practice? Remember what century this is? I hope everyone out there isn’t practicing “common-sense” dentistry. After all how could the earth be round?

  30. As a Periodontist, I have been placing dental implants for 20 years. Dental implants are the best thing that happened to dentistry. However the best dental implant is….a natural tooth with a functioning periodontal ligament! It is absurd to even think of extracting a tooth with a pulpitis or chronic periapical infection and place a dental implant! Even so many re-treatments of failing RCT’s are indicated and can be justified. Of course I agree with a previous poster that Herodontics is a loosing battle in the face of the overwhelming predictability of dental implants. The focus on saving the tooth has clearly shifted to saving the alveolar bone.

    I believe that here will always be a strong need for endodontists! In fact I strongly feel that there will be an increased demand for endodontics in the future for three reasons:

    1. With the increased use of Cone Beam Scanners more and more endodontic lesions are being discovered that were previously left untreated. Ever since I started using Cone Beam CT I have become a major referral source for the local endodontists! (I refer out about 100 scans a year to the radiology lab)

    2. Already high resolution images from CBCT scanners are aiding endodontists in better identifying the anatomy previously hidden on 2D radiographs.

    3. The increased use of inadequate/failing adhesive dentistry will increase the number of devitalised teeth.

    On Endodontists placing implants I have mixed feelings. Endodontists, like GP’s are surely intellectually and technically capable of learning to place dental implants. Anyone who wants to put in the time, labor, money and sweat can become good at this. However, it is not as easy as your implant rep. is leading you on to believe. While he/she is patting you on the back and selling you the implant kit. Remember, they get a fat commission for selling you those kits and the only thing the dental implant company cares about is selling you implants. The reps don’t have a dental degree and license to loose. Just beware as danger lurks beyond. You have to ask yourself the question as an endodontist if you want the headache and liability of that treatment modality. Most of the time the most difficult part of the dental implant procedure is the extraction of the failed tooth and a lot of complications come with that. In addition, for anterior teeth the difficulty and liability increases exponentially with the cosmetic demands of a case. As the previous poster pointed out that many times “unexpected” bone and soft tissue regenerative procedures go hand in hand with dental implant therapy. Many of the complications, overhead, experience and skill go hand in hand with these complications.

    I was an endodontist that hates doing root canals I would go back to school and become a GP or an implantologist or …a real estate agent.

  31. Thank you,

    I went to a seminar on implants, and was supprised to find out dentures are very bad, and uncomfortable. Not to mention one can’gt taste one’s food.

    A complete implant set of teeth, crowns, and implants cost about $75,000. How is the average person able to afford this amount? Is there another option besides going without teeth?

    Thank you,
    William nodler

  32. Mr. William Nodler,
    Full overdenture set (implants, crown, etc. everything) should not cost more than $30,000 for a normal case. Extremely case involve a lot of bone graft (if there are not enough left bones for implants) + sinus lift if required. Only then, the cost might increase up to $50,000. There is no such thing as $ 70,000 price tag as you claim.

  33. For a single arch there probably isn’t a 70,000 price tag, but for the full mouth (both arches) then yes, there is such a thing. The average person can’t afford it. That’s top end fixed bridgework, but there are quite a few points inbetween dentures and fixed bridgework that are more affordable. No matter how you slice it, missing teeth are expensive.

  34. Again, I do not think a full overdenture anchored on implants, in normal case, would exceed $ 30,000. Let us calculate: Let say, we need 6 implants per upper or lower arch, and assuming $ 1500/implant = $ 18,000 for 12 implants. The “gold frame” connecting the implants @ $ 2000/ arch. The full crown is @ $ 4000/arch = $ 8000 for two arches. Then the total = $ 18,000 + $ 4000 + $ 8000 = $ 30,000.
    I think the estimated prices used are the norminal price (of course you will see some higher and lower.) But a normal case would be @ the $ 30,000, give or take.

  35. To all concerning endo vs implants:
    As a practicing endodontist and knowledgable clinician, I find it hard to believe anyone is under the misconception that root canal success is so poor. “Outdated” lit extracted from dental school studies and general practice outcome figures should be banned from closed-minded readers. The fact is, root canal success when performed by a qualified clinician (specialist or GP) is typically as successful as implant services.
    Root canals that fail are performed by clinicians who try to “beat the clock” and say, “I do 45 minute molar endo”. Why do these cases fail? We are not respecting the biologic principal of removing the nidus of inflammation. Spend more time locating and debriding the canal systems rather than filing to the “first that hits the apex” and shoving some gutta with sealer into the tooth.
    Implants should be used when we can truthfully say that endodontic treatment is not viable. I refer a patient for implants quite frequently. This is usually after the integrity of the tooth has been horribly damaged by a clinician (specialist and gp’s) and I know that my therapy is now on shaky grounds. Perforations, ledges, blockages, etc are all avoidable. if we take our time and know our limitations we will be providing the best course of treatment for who matters most–our patients.
    Endodontists, GP’s, Periodontists, etc should all be working together as a community of dental health professionals to ensure that our patients are receiving the utmost in quality dental care.
    And please…site updated literature.

  36. I hate to be the fly in the ointment but, with regards to the literature, sometimes the satistics quoted do not reflect reality. I have worked with a surgical operating microscope for over ten years and perform virtually all of my implant surgery with it.The implant procedure that is growing out of proportion with all others is extraction/immediate implant placement. With regards to endodontically treated teeth, upon extraction and visualization of the apex of the osteotomy, I have found that 100% of these sites have remnants of apical granulomas! Well sealed RCT’s have the smallest areas, but they remain regardless of the site. I believe that the 28% complication rate, quoted in the literature, is caused by remnants of granulomatous tissue containing vegetative pathogens which are activated by cytokines released by the surgical procedure. We now routinley use the Er,Cr laser to debride these lesions and kill the vegetative bacteria, giving us success rates equal to healed sites. RJM

  37. IMHO implants affected 2 aspects of endo, number one is the retreatment, well it did lower the need to do herodontics to salvage a tooth.. if there’s a big abcess or a difficult ledge or whatever then extraction and implant placement seems more predictable.
    Also it somehow replaced surgical crown legnthinig as it is more conservative to extract a root than to remove 4 or 6 mm of bone to restore it.
    So in other words implants affected herodontics and not endodontics.

  38. Endo tx works well———–for a while! We have to face the facts, fillings fail, crowns fail, bridges fail. All of these treatments run their course. However, they have a place at the time. Tires and breaks don’t last either. All this treatment is subject to failure, even implants fail. We have to expect that we are going to replace prior treatment just because of the basic facts of cycling, biomechanical wear, decay, perio disease and patients being patients!

  39. Hi everybody

    Do you know any orthodontist (not the one used for temporary anchorage) who places Dental implants,what do you think about that?

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