Dentaltown February 2018 - 99

and TruShape from Dentsply Sirona are
two such systems that have only recently
come to market.6
Furthermore, there are NiTi files specifically designed to nicely manage calcified
canals and create a "glide path"-initial
canal instrumentation that extends from
the orifice to the apex-with reduced canal
transportation and ledging.7 (See Table 1.)
So calcified or very curved cases that we
once thought couldn't be instrumented (or
instrumented safely) can now be treated very
nicely with the combination of enhanced
magnification and new NiTi mechanized
files.

Fig. 3

Figs. 3-5: Better diagnosis and treatment is possible thanks to
improvements in dental loupes and lights, such as those from
Designs for Vision (Fig. 3), and in dental microscopes such as the Carl
Zeiss Extaro 300 (Fig. 4) and Global Surgical A-Series (Fig. 5).

Implants do not have better
'success' rates than root canals
We are fortunate to have dental implants
available as a treatment option. However,
with time come outcome studies and the
humble reality of postsurgical outcomes. An
increasing number of studies are evaluating
the outcomes of dental implants. They have
shown that, unfortunately, they do not
work as well as we'd thought-or, shall I
say, as well as we had perceived.8 It's likely
that you've been hearing more and more
about "peri-implantitis," an inflammatory
disease that affects soft and hard tissues
around dental implants. 8 This, in turn,
leads to compromise in long-term prognosis
of dental implants.9
Root canals have been evaluated under
stricter criteria than implants. The word
"success" has often been misused in dental
implantology; the perception has been
that if the implant site is asymptomatic
and the implant is functional, it's successful, no matter the cervical bone loss or
peri-implantitis present.9 Figs. 1 and 2 are
certainly not successes, but instead should

Figs. 1 and 2: While #3 (left) and #19 (right)
implants are functional and asymptomatic, they
show cervical bone loss and are not "successes."

Fig. 4

be considered "surviving" implants. When
comparing apples to apples with respect
to "success," root canal treatments have
been shown to easily be just as successful
as implants.10,11
A recent study evaluated 588 randomly
selected implant cases and followed them
for nine years.9 It found that about 45 percent of cases presented with some form of
peri-implantitis. That's a very humbling, and
potentially troublesome, outcome. If only a
few years after insertion, so many implants
show disease around them, then what will
there be 10 or 20 years later? And if/when
an implant is failing with peri-implantitis,
what do we do? Unfortunately, we currently
have no idea.
So, considering the success of root canal
treatments and that of dental implants, it
seems that root canal treatments will remain
a well-proven and sound treatment option.

Fig. 5

dentaltown.com \\ FEBRUARY 2018

99
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Table of Contents for the Digital Edition of Dentaltown February 2018
