Endodontics
the phoney war Endo versus implants:
The vast majority of clinicians know the value of endodontics and implant therapy and should embrace both for better patient choice and care, says Bob Philpott consultant in endodontics at Glasgow Dental Hospital
A
lthough difficult to quantify precisely, the use of dental implants has
increased enormously in the last 20 years. Figures from the US suggest that, from 1983 to 2002 alone, their use increased ten-fold. It is estimated that more than 200,000 implants were placed in the UK in 2013. Coupled with that, implant placement and restoration in a general practice setting has become more common in the last decade. There is no doubt that dental
implants have become a viable treatment modality in the replacement of missing teeth. Quality of life improvements have been highlighted in both edentulous (Curtis et al. 2009) and partially dentate patients (Pavel et al. 2012). Studies report survival rates of implants in the region of 82 to 94 per cent over a 10-year period (Holm- Pederson et al. 2007), although factors such as smoking, untreated periodontal disease and diabetes may adversely affect the outcome. (Fig 1) Unfortunately, this has led
Fig 1b
Fig 1a Fig 1
Radiograph and photograph showing successful implants in 21 site (courtesy Dr. Rory Nolan, Melbourne) and successful endodontic re-treatment and direct cuspal overlay restoration of tooth 36
to a paradigm shift in relation to the treatment planning of teeth with a questionable prog- nosis. Traditionally, clinicians assessed teeth on the basis of a multitude of patient and dentist-related factors (Kalsi and Hemmings 2013). More frequently today, teeth to be considered ‘guarded’ in terms of their periodontal, restorative and/or endodontic prognoses
are not being considered for rehabilitative treatment. As clinicians, we need to be
introspective on these issues more than ever before. Kay and Nuttall proposed the idea that, as individuals, we will always have both perceptual and judgemental differences in relation to treatment planning of particular cases. More worrying were the findings of
Kvist and Reit (2002) in their series of papers on treatment planning in endodontics, which suggested that most people rely on a series of heuristic principles to make treatment planning decisions. Therefore, there are a number of key questions we need to answer in this debate
Continued » Scottish Dental magazine 53
Fig 1c
Fig 1d
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