Dentaltown February 2018 - 101

Root canals are not
preludes for implants
Knowing the prognosis of well-performed
and restored endo-treated teeth, should we
really give up on a tooth for an alternative
that, within a short period of time, may
have cervical disease that we still have no
way of treating?9 (See Example 2.)
Better yet, let's look at the world of
orthopedic surgery. You'd be hard pressed
to find orthopedic surgeons recommend a
total knee replacement on a relatively young
patient; you're much more likely to hear
them suggest managing the injured knee
for as long as possible before replacing it.
And unlike in dentistry, orthopedic surgeons
almost always advise patients that their new
knees will likely need to be replaced after,
say, 10 or 15 years, so the longer the initial
surgery is held off, the better. Why we don't
state this to our patients with respect to
dental implants-or why we don't state it
more often-is a question I can't answer.
So, we should do what we can to hold
on to a structurally sound tooth by means
of endodontic treatment. In other words,
root canal-treated teeth are certainly not a
prelude for dental implants.

Improved diagnosis means
better case selection
To a great extent, thanks to CBCT and
dental microscopes, we can now better select
cases that would benefit from endodontic
treatment and weed out those that won't.
One may argue that weeding out poor
candidates for endo treatment might further improve endodontic outcomes. Time
will tell. Examples may include a vertical
hairline fracture that's seen only under a
microscope. (See Example 4.) Such a case
would not benefit from endo treatment in
the first place. Nowadays, there is less of
a need for exploratory endo surgeries or
exploratory endo accesses. This, in turn,
saves patients the time, money and pain
of such procedures. These diagnostic tools
could greatly enhance the endo experience
and outcomes, when poor candidates are not
endodontically treated in the first place. A
recent study demonstrated how the use of

CBCT in endodontics altered treatments in
most cases reviewed. CBCT saved patients
from unnecessary endodontic treatments that
may have been unsuccessful if pursued.12

Summary
Not only do endo-treated teeth have
exceptionally high success and survival
rates, but we can now diagnose and manage
endo-related problems better than ever.1,12 To
a great extent, this is thanks to the impressive
advances in endodontic techniques and
armamentaria. For instance, we can now
more predictably and more safely manage
very calcified and curved canals thanks
to narrow, flexible mechanized NiTi files.
(See Table 1.) We can more easily and more
frequently locate difficult-to-find canals that
are related to endodontic failures, such as
MB2. And, unlike ever before, we can now
diagnose and treat complex endo-treated
cases thanks to CBCT imaging.
So, while we are fortunate to have dental
implants available to our patients, with the
aforementioned endodontic prognosis and
the limitations of implants, there is certainly
a very healthy future for endodontics. ■
References:
1.
Burry JC, et at., Outcomes of Primary Endodontic Therapy
Provided by Endodontic Specialists Compared with Other
Providers, J Endod, 2016; 42:5, 702-705.
2.
Schwarze T, et al., Identification of second canals in the
mesiobuccal root of maxillary first and second molars using
magnifying loupes or an operating microscope. Aust Endod J.
2002 Aug; 28(2):57-60.
3.
Hargreaves, K. Pathways of the Pulp, 11th edition, Elsevier
Inc, 209 - 279, 324- 386, 2016
4.
Abn S-Y et al., Kinematic Effects of Nickel-Titanium Instruments With Reciprocating or Continuous Rotation Motion: A
Systematic Review of in Vitro Studies, J Endod, 2016; 42:7,
1009-1017.
5.
Yang, Y et al., A Micro-Computed Tomographic Assessment
of the Influence of Operator's Experience on the Quality of
WaveOne Instrumentation. J Endod 2016; 42:8, 1258-1262.
6.
Lacerta M, et al., Cleaning and Shaping Oval Canals with
3 Instrumentation Systems: A Correlative Micro-computed
Tomographic and Histologic Study, J Endod, 2017;6, 32.
7.
Peet van der Vyver. Creating a glide path for rotary NiTi instruments: part one. International Dentistry 2011; vol. 13, 2:14-25.
8.
Derks J et at, Effectiveness of Implant Therapy Analyzed in
a Swedish Population Prevelance of Peri-implantitis. J Dent
Res, 2016; 95(1), 43-49.
9.
Tarnow D, Increasing Prevelance of Peri-implantitis: How
Will We Manage?, J Dent Res, 2016;95:1,7-8.
10. Setzer and Kim S, Comparison of Long-Term Survival of
Implants and Endodontically Treated Teeth, J Dent Res, ,
2014 Jan 23(1), 19-26.
11. Fernandez R et al., Survival of Endodontically Treated
Roots/Teeth Based on Periapical Health and Retention: A
10-year Retrospective Cohort Study, J Endod, 2017;8(3)
12. Ee et al., Comparison of Endodontic Diagnostic and
Treatment Planning Decisions Using Cone-beam Volumetric
Tomography Versus Periapical Radiography, J Endod,
2014;40:7,910-91.

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