Implants vs Endodontic Treatment
Although general dentists receive training in endodontics during their education, many prefer not to provide root canal therapy, particularly when surgical intervention is required. There are several reasons for this reluctance to perform surgical endodontics, not the least is the general perception of patients that “root canal therapy” is an unpleasant, long‐drawn out procedure that can be uncomfortable at best and at worst is painful. In fact, to a great many patients, the words “root canal therapy” are synonymous with any procedure or experience that is to be avoided at almost any cost.
In contrast, non‐surgical endodontic treatment is a predictable treatment choice if certain conditions are met. First, there must remain enough sound tooth structure to achieve a 2 mm ferrule effect 360° around the tooth. This will ensure long‐term stability of restorative treatments. Secondly, a cause‐and‐effect should be established when diagnosing a symptomatic tooth. For example, caries approximating a pulp horn with symptoms lead to a clear diagnosis of irreversible pulpitis. Conversely, a symptomatic tooth with no caries present leads to a less predictable treatment outcome until and unless a definitive diagnosis can be achieved.
When there is need for “root canal therapy,” the operator must have available a specialized armamentarium of instruments and restorative materials. However, it must be stated that the available instrumentation and endodontic sealer cements have improved dramatically over the past 20 or so years. Further, it is generally recognized that the time and expertise required to perform endodontic surgery increases almost exponentially with the number of tooth roots/canals to be treated. Additionally, when canals are sclerosed or calcified, there is increased difficulty in ensuring a clean and extirpated pulpal chamber and root canals.
Finally, teeth that have received extensive endodontic therapy tend to embrittle over time and are subject to failure under loading. Further, it is difficult to achieve a complete hermetic seal of a root canal so that apical leakage and ingress of bacteria, blood and other matter into the treated canal can occur over time. Coronal migration of tissue fluids and bacteria leaking into the treated root canal over time can have many untoward consequences, including dentinal staining, breakdown of sealer cements and restorations, pain and discomfort as well as infection. Due to risks associated with endodontically treated teeth, dentists are often reluctant to use these teeth as abutments for both FPDs and RPDs.
In contrast, the success rate of dental implants is 95–97%. This is far higher than treatment of symptomatic teeth with marginal ridge fractures and endodontic retreatment. These success rates must be considered when discussing treatment options, particularly when relative costs, patient time‐commitment to treatment as well as patient discomfort are considered in addressing the question of root canal therapy vs placement of an implant.
Conclusions
Having presented the overall case for dental implants, specific factors regarding the placement and clinical application of implants will be covered in detail in the following chapters. Nevertheless, modern dentistry now recognizes that dental implants are the standard of care for prosthetic replacement of missing teeth. This is because they can readily and conveniently address some otherwise seemingly intractable problems in traditional restorative dentistry. Further, the advances in implant technology and dental science have progressed so markedly since the first days of the Brånemark concept that the outcome of dental implant placement has a success rate over 95%.
The final word should be that the ground‐breaking concept of Per‐Ingvar Brånemark has transformed dentistry and dental treatment for even the most challenging cases.
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2 A Brief History of Dental Implants
Dentistry has a venerable history in that prosthodontics has been practiced for several thousand years. Fine examples of dental bridgework dating from around 700 BCE were crafted by the Etruscans of Central Italy (now Tuscany) and fixed partial dentures are known to have been fabricated by the Maya of Central America as far back as 700 CE [1–4]. There are many well‐known figures in history, for example, Queen Elizabeth I of England, King Henry II of France, George Washington of the United
