Dentaltown March 2013 - (Page 26)

second opinion column » Should Endodontists Place Implants? by L. Stephen Buchanan, DDS, FICD, FACD Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a “second opinion.” Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. – Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine In recent years, the question “Should endodontists place implants?” has crossed the minds of virtually every endodontist in the U.S., if not the world. Opinions range from yes to maybe someday to never. The objective of this article is to explain to general dentists the advantages of their local endodontists placing implants when a tooth with failing RCT is unfit to be saved, but also to answer the concerns of endodontists who answered “maybe someday.” The endodontists who said never… well, I can’t help them. For general dentists, having an endodontist place implants is a positive. If your local endodontist does implant surgery and that is not who you want to place implants in your patients, just say “no” when he or she asks. You’ll never get an argument, and if you say “no” a couple more times, your local endodontist who does implant surgery won’t even ask, he will simply refer your patients with unsalvageable teeth to another surgeon of your choice. Even when referring dentists prefer another implant surgeon, endodontists who have trained up to place implants are more likely to be on the same page as the GP when it comes to treatment planning for a sketchy tooth. Endodontists who place implants are the least biased of all specialists who place implants, simply because they are the only implant surgeons who can do either procedure. Implants qualify as one of the greatest advancements in the history of dentistry. Implants have changed every specialty (except maybe pedodontics) and the whole of general practice forever, but I’ve seen it up close in the specialty of endodontics. Implant placement has radically morphed periodontal practice from a dreary specialty to a really cool, effective and profitable field. The aesthetic advancements that periodontists have brought to the implant party are truly remarkable. The specialty of prosthodontics has changed nearly as much. Prosthodontists used to deal with slowly deconstructing full-mouth cases with few options besides removable prostheses after a certain point. Now, with the right implant placement, prosthodontists have become like Superman – they can put anything back together. Just as the periodontists did 20 years ago, many endodontists have now trained up and implant surgery is a significant part of their practice. However they (we) are still a small minority of the specialty, so the majority of the changes to endo from implants have been less direct, but in significant ways that have irrevocably improved our treatment planning, and thus our success rates. The best of those changes has been the fact that we are no longer asked to do heroic endo to save precarious teeth because they are the last distal abutment in an arch. Most of the teeth that were hemisected and root amped by periodontists back in the day were successfully treated by endodontists only to fail structurally when the same occluding forces were borne by fewer roots. Endo heroics aside, the greatest positive change the implant era has delivered to our specialty has been endodontists placing implants. When my colleagues ask how an endodontist, not trained in implant placement in grad school, can rationalize including implant surgery in their practice, I answer: 1. Everybody places implants, even orthodontists. The only dentists who think endos shouldn’t place implants are insecure implant surgeons and endodontists who don’t really feel comfortable doing endo surgery. 2. The majority of periodontists weren’t trained to place implants in their graduate programs either, yet they have done magnificent work. Weren’t periodontists rather uncomfortable when they began to cut bone near maxillary sinuses and mandibular alveolar nerve canals? Endodontists who do apical surgery on premolars and molars have been there their whole careers and are usually unconcerned by those situations. continued on page 28 26 MARCH 2013 » dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown March 2013

Dentaltown.com Highlights
Howard Speaks: Dentistry Could Come Back with a Vengeance
Professional Courtesy: I’m No Anti-Dentite
Continuing Education Update
Second Opinion: Should Endodontists Place Implants?
Needle Stick Question
Am I the Only One Who Didn’t Know How to Use My Loupes?
The Patient Blames Me for Cracking His Tooth
Corporate Profile: {KöR}
CAD/CAM Materials
Dentaltown Research: Cosmetic Dentistry
Do-it-Yourself Finance, Part IV: Savings and Investing
Product Profile: Centrix
Keep Them Coming Back
You Should Know: Likeable Dentists
Multimodality Endodontics
Endodontics for the Recent Graduate: Instrumentation
Continuing Education Porcelain Veneers: From Case Selection to Cementation
8½ Tips for Dental Safety Checklists
How Prepared Are You For a Medical Emergency?
Dental Stem Cell Preservation and the Dawning of Regenerative Oral Medicine
Product Profile: Ivoclar EvoCerem
Narrow Diameter Implant Overdentures with Locator Attachments
In This Issue: Zeroing in on Xerostomia
Perio Reports
Ad Index
Profile in Oral Health: Substances for Targeting Xerostomia
Dentally Incorrect

Dentaltown March 2013