Please activate JavaScript!
Please install Adobe Flash Player, click here for download

Dental Tribune United Kingdom Edition

22 United Kingdom EditionClinical May 16-22, 2011 convenient& pr ofessional for all your Core Subject needs visit www.corecpd.com Email info@smile-on.com or call 020 7400 8989 wherev erandwhenever W hen I admit to being an endodontist I receive a look of pity from my peers. Unfortunately, with dental implants growing in popularity, this field of dentistry is often re- garded as outdated - a dying art. If a tooth is deemed unrestor- able, or retaining the tooth could make future implant placement more difficult due to infection and further bone loss, then of course extraction and appropriate re- placement should be considered. However, with an ageing popula- tion, implant surgery may increas- ingly be contraindicated. It is the role of the clinician to weigh up their options and select the appropriate solution for each patient on a case-by-case basis. Implants are not the ‘be all and end all’ of restorative treat- ment. Rather than instinctively reaching for the forceps, some clinicians need to reconsider their attitude towards alterna- tive methods of saving a tooth. I have heard post crowns being re- ferred to as ‘PRPI’ or provisional restoration pre-implants. Given there is sufficient tooth structure and sufficiently long roots, post crowns can actually have a very good prognosis and shouldn’t necessarily be automatically con- sidered as a temporary solution. What’s more, implants are not necessarily as atraumatic as they are sometimes perceived to be. They necessitate a CT scan, a surgical procedure and a long period of temporisation while waiting for integration. For a suitable patient, good en- dodontics on the right tooth avoids the need for this trauma and expense. It will also mean the patient can retain their natural tooth, heightening proprioception. ‘Success’ in endodontics is not easy to define and is the subject of much debate amongst endo- dontists themselves. A successful implant treatment can be defined by whether or not the implant has integrated or ‘survived’. The success rates lie somewhere be- tween 85-95 per cent; however to decide whether treatment can be deemed a success in endodontics, consideration needs to be given to the desired final outcome. Is endo- dontic treatment a success when the patient is free from pain and swelling? Or can the treatment be considered a success when no lesions are present? As a result, success rates for endodontic treat- ment can vary from 45 per cent to 95 per cent. Dentists need to be able to make an objective decision based on the most favourable outcome for the patient. A growing trend in endodontics courses in the US is for students to learn to treat im- plants too, enabling a fractured tooth with plenty of bone to be suitable for immediate implant treatment. This trend looks set to catch on in the UK, with the result that endodontists will be able to undertake the best treatment. In short, we have to ask our- selves, ‘what’s the worst that could happen?’. Do we really want a long bridge with a short root filled tooth with a post as an abutment, or should every compromised tooth be replaced with an implant? If both treatments have the same longevity and no adverse factors then ultimately it comes down to operator experience and confi- dence as well as informed patient consent. DT The Endodontosaurus – A dying breed? Michael Sultan discusses attitudes towards alternative methods of restoring teeth About the author Dr Michael Sultan BDS MSc DFO FICD is a specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for five years before com- mencing specialist studies at Guy’s hospital, London. He completed his MSc and in Endodontics in 1993 and worked as an in-house endodontist in various practices before setting up in Harley St, London in 2000. For further information please call EndoCare on 0844 893 2020 or visit www.endocare. co.uk