Dentaltown February 2018 - 97

Abstract
Some dentists have equated the recent
uptick in dental implant use with the
impending collapse of endodontic treatment,
saying that implants "work better" than
root canal treatments. But the evidence
from recent studies reveal that the success
rate for endodontically treated teeth is
high even a decade after initial treatment,
while the growing evidence related to the
incidence of peri-implantitis in teeth treated
with dental implants is troubling in its
own way. With improved instruments and
imaging technology, root canals will remain
a well-proven treatment option to preserve
structurally sound teeth.

Educational objectives
After reading this article, the participant
should be able to:
1. Identify the successful outcome rate
of endodontically treated teeth five
and even 10 years after the original
treatment in private practice.
2. Recognize the role of improved
visualization, thanks to loupes and
dental microscopes, in helping to
identify potentially difficult and
calcified canals.
3. Understand how improved nickel
titanium (NiTi) files have made
it easier to successfully perform
endodontic treatment.
4. Consider the reported incidence of
peri-implantitis symptoms in implant
cases.
5. Understand how improvements in
3-D imaging technology can help
determine whether a patient is a true
candidate for successful endodontic
treatment.

Introduction
With the increased popularity of dental
implants, there has been a growing perception
that the future of endodontics is bleak.
You often hear colleagues saying things
such as, "Root canals don't work, so why
bother?" "Endo is just a prelude for an
implant" or, "Implants work better than

root canals." Many might also think that
teeth with complex anatomies, such as
calcified or curved canals, simply can't be
treated endodontically. And many patients
often say, "I got a root canal and then lost
my tooth," referring to a tooth that cracked
after endodontic treatment.
With this in mind, let me explain why
endo has a very bright future and is here to
stay, and why we're fortunate to have it as
a treatment option.

Root canals do work
Numerous studies have shown that
well-performed, well-restored root canaltreated teeth have excellent outcomes. A
recent "real world" endodontic study looked
at 487,000 initial root canal-treated teeth
performed in private practice.1 It found
that five and 10 years after endo treatment,
92 percent and 86 percent of the cases,
respectively, did not require extraction or
endo re-treatment or surgery. Keep in mind
that many of those cases were performed
in less-than-ideal clinical standards, and
not always ideally restored. Furthermore,
these cases were performed with endodontic
instruments that nowadays seem outdated,
because treatments were from as far back as
2000. It's difficult to argue such numbers.
One wonders what the outcomes would have
been if those cases were treated with current
generation of endodontic armamentaria and
protocols, and were routinely well restored
after the treatments!
Of course, a poorly done endo-missed
canals, underinstrumented or undermedicated, a likely contaminated canal system
because of a lack of rubber dam isolation,
etc.-will not have a good prognosis. But the
same would hold true for a poorly executed
implant procedure.
With the introduction of many advanced
instruments such as enhanced magnification,
improved mechanized nickel titanium (NiTi)
instrumentation, and intracanal means to
medicate canals, endo can now be performed
more efficiently and predictably, meaning
there's less room for error. With improved
visualization, such as loupes with LED

Meet this featured
speaker at Townie
Meeting 2018!
Dr. Manor Haas will be one of the
featured speakers at Townie Meeting
2018, which runs April 11-14 in
Orlando, Florida. To discover more
about the event, or to reserve a hotel
room at the Townie Meeting discount
rate, visit towniemeeting.com.

Disclosure:
The author declares that neither he
nor any member of his family has a
financial arrangement or affiliation
with any corporate organization
offering financial support or grant
monies for this continuing dental
education program.

dentaltown.com \\ FEBRUARY 2018

97
http://www.towniemeeting.com http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown February 2018
