Endodontics
Fig 4a Fig 4
Radiographs showing healing of periapical lesion associated with 2 teeth following endodontic treatment (both originally had a 10mm pocket at the midbuccal aspect and a crack was suspected)
principles will give patients value for money and clinicians peace of mind.
Fig 5
Radiograph showing failed root canal treatment in unrestorable tooth 16 adjacent to successful endodontic/implant therapy in 15/14 sites respectively
ABOUT THE AUTHOR
Bob Philpott graduated with a BDS from the Cork University Dental School. He subsequently completed a house officer position at the University Hospital of Wales in Cardiff and undertook his specialist training in endodontology at the Eastman Dental Hospital, London, completing his membership in restorative dentistry of the Royal College of Surgeons, Edinburgh.
Is it a turf war? In a recent editorial in the Journal of Prosthodontics, the rivalry that has developed between both camps was discussed. There is no doubt the atmosphere in dentistry worldwide has become less collegial as time has gone on. The current economic climate and the increased competition has led us this way. This, together with the expansion of implant dentistry in a general practice setting, has made the competition more intense. Competition is a good thing.
Bob has specialist registration in both England and Australia, having spent two years in Melbourne working in private practice and at La Trobe University as a clinical supervisor.
At the end of 2013, he returned to the UK to take up a position as a locum consultant in endodontics at Glasgow Dental Hospital.
decision is made to extract and replace a root filled maxillary anterior tooth with an implant (with trends showing that immediate place- ment and early loading are becoming more common) instead of treating it surgically, bearing in mind the aesthetic outcomes can often be far less than ideal on follow up (Evans and Chen 2008).
Costs to the patient Direct comparisons between the two treatment modalities on a financial basis reveal that restored single tooth implants cost 75-90 per cent more
than similarly restored endodontically treated teeth based on data from the US (Christensen 2006). Comparisons should not,
however, solely focus on cost. Improvements in our patients’ quality of life must be factored in and the long-term satis- faction rate of patients with endodontically treated teeth is comparable to those receiving implant therapy (Dugas et al. 2002, Curtis et al. 2009). Our treatment decisions should be evidence based, patient centred and taken with longevity/prognosis to the forefront. Adherence to these
It benefits both dentists and patients alike. It is argued that, as competition increases, prices should come down. However, what we as clinicians cannot compromise on is our quality and our adherence to the biological principles of dentistry, the fundamental backdrop to carrying out invasive treatments on patients. Some of our more oratorical colleagues in the US often make reference to the daughter or ‘mama’ test during their presentations, where they basically encourage us to ask ourselves whether it would be the treatment we would propose for our own families. There is no doubt that, as clinicians, we are sometimes blinded by what we know. Tunnel vision among the endodontic fraternity often means that teeth with a ques- tionable (or worse) prognosis are treated, without due regard for longevity. Equally, it has become
apparent many salvageable teeth are being extracted and replaced with implants. This swiftness to condemn a tooth without first exhausting attempts to maintain it can be a costly one, both biologi- cally and financially, to the patient (Fig 4). As I have already mentioned,
comparisons between the two treatments are difficult, if not impossible and, when made, are often not particularly relevant. Can we really compare like with like in this case? The language used to describe both treatments should be more standardised and evidence based, allowing our patients to make informed decisions. We must also reflect carefully
on the risks and cost benefit to the patient. Risk factors for failure of both treatments have been well documented. Rubber dam use, adequate
obturation and placement of a well-fitting coronal restora- tion are essential to ensure favourable outcomes in endodontic treatment. Equally, correct surgical
technique and experience, biological factors (diabetes and periodontal disease) and correct prosthetic rehabilita- tion are key to successful implant therapy. The vast majority of clinicians know the value of both treatments (Fig 5). In 2012, more than 130,000 endodontic treatments were completed on the NHS in Scot- land, while implant placement has increased exponentially in the last decade. This trend will continue and
it is one we should all embrace. It gives our patients choices.
Scottish Dental magazine 55
Fig 4b
Fig 4c
Fig 4d
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