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Implants Impacting Endodontics?
Steven asks us:
I am going into my fourth year of dental school and am trying to figure out what direction to go after I graduate. My family dentist encouraged me to go into a specialty and he recommended endodontics.
I have completed one research project in endo which I hope to publish. But I wonder if endo is going to draw down because of the number of dental implants that are being placed. In fact, I have heard that that many patients are opting for dental implants instead of endo. Interestingly, I even recently saw an advertisement for a dental implant placement course Nobel Biocare is giving specifically for endodontists. So, my question is: should I apply for endo? With the growth in the dental implant market, will there even be enough endo for me to make a living? Is the future of endo in dental implants?
July 17, 2006 in Implant Practice Management | Permalink
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Comments
If you love endo go into endo. There will always be a need for endo. To say that every tooth that requires endo should come out and get replaced by an implant as a blanket treatment is a disgrace.I'm a gp I place implants and I do my own endo. Neither one knocks the other out of the ballpark.Sometimes the implant would be the prudent choice. Most of the time I try to save the teeth if they're in good condition otherwise. Besides, what about retreatments.? If anything apicos should be a thing of the past. If you are a crackerjack endodontist you'll find that you could get referrals for the retreat instead of subjecting the pt. to the apico crap shoot.Do what you love,success will follow.
Posted by: Dr. R Mosery | Jul 18, 2006 2:12:10 PM
There are many cases that implants are chosen over endo in the difficult retreat, the patient who has had endo failure and/or crown/bridge failure, etc. How far this trend would go in the immediate future to affect your career is unknown. There are endodontists who are concerned and want to get into implants, just as periodontists did to turn around their specialty. I would agree with Dr. Mosery to do what you love.
Posted by: | Jul 18, 2006 3:01:53 PM
So long as gp's are doing crown and bridge, there will always be a need for endo. When a patient has just spent over $1000 for that new crown and the pulp goes, are we going to advise our patient's to pull these teeth and get an implant and a new crown? Of course not. The majority of cases you will see as an endodontist have some sort of prosthesis fixed to them. So I say, go for endo, if you love it. And if endodontist's start placing implants, hoorah! They're the one's that technically should be placing them anyhow. This paradigm shift is just an illusion. Natural teeth will always be saved; we practice dentistry remember.
Posted by: Joseph Zerella | Jul 18, 2006 3:23:17 PM
Marry a person you love or a person look having good future. There is no correct answer in life. Decide now and feel the result of your decision later.
Posted by: Yong-geun Choi | Jul 18, 2006 3:59:01 PM
I agree with with above comments, there will always be a need for endo, but there is already definite paradigm shift away from the "herodontics" that we've all practiced in the past. I vary rarely perform or recommend the "endo retreat, hemisection, post & core, new crown" route anymore. Implants are far more predictable and in the long run will cost the patient less. But there will always be a need for endodontists and I have yet to see one starving. So if you enjoy it, do it.
To Dr. Zerella: I was just wondering why you think that endodontists "technically should be placing them anyhow." Nothing against endodontists at all I think they're great, but the ones I know generally don't like surgery, haven't extracted a tooth since dental school, have never done a bone graft, sinus lift, ridge augmentation, or a block graft nor do they work with occlusion on a regular basis. This is not to say that they aren't perfectly capable of learning how to do it, but wouldn't a surgeon (perio or OMS) or a GP with surgical experience be a more qualified individual to place implants?
Posted by: Robert Cain | Jul 18, 2006 4:24:48 PM
The endodontist to whom I refer also places implants. Although I perform endodontics and place implants as well, when I refer a difficult case I expect my endodontist to provide the best option to our mutual patient. Because he can provide either treatment, I know the patient will receive the most appropriate care. I value this service as do my patients. As an aspiring endodontist you should be sure to master implant placements as well as endodontics and offer this as a beneficial characteristic of your practice.
Posted by: | Jul 18, 2006 5:23:30 PM
The honest and ethical dentist will do what is best for the patient, not his or her bottom line. There will always be a need for both forms of treatment especially when outcome assessment studies are performed properly and fully understood by the profession.
Posted by: Fred Barnett | Jul 18, 2006 7:07:57 PM
There is no doubt that Implant dentistry has changed the practice of endo as well as perio.
As far as periodontists are concerned many are more intersted in extracting the questionable teeth and replacing them with implants rather doing hard core perio to save them.
May be it is economically more rewarding.
But as far endo is concerned still there will be enough endos to be done,
because
1,some patients may wants to save their own natural teeth.
2,some patients still may count the difference in fees between endo and implant.
3,many dental insurances do pay for endo but not for implants.
4,some patients may not be fit medically for implants or major grafting procedures.
5,some patients may be just afraid of those surgeries.
6,there are more stories floating around among patients about complications from implant and grafting surgeries than from endo.
7,time difference between finishing endo restoration and implant rstoration may be an obstacle to some for implants.
8,extra need and expense for provisionals may be deterrent to some.
In my opiniion if endos are being done efficiently and carefully success rate of endos is more or less equal to implants.
But if tooth requires endo,post,crown and crown lengthening, implant should be considred.
If tooth also needs apico,just go ahead with implant.
as long as resin restorations are being placed by less trained clinicians,there will be plenty endos in near future,
I can not say for your life.
Endo is a very good branch, you will have succeess.
But in worst scenerio you still can learn implant dentistry and start placing imnplants.
Why are you worrying now?
As matter of fact I have friend,who after finishing endo joined 2 years fellowship in implants and practices both now.
Posted by: satish joshi | Jul 18, 2006 8:00:32 PM
just to say that, sometimes, the better endo treatment is a... good fixture!
Posted by: | Jul 19, 2006 1:14:17 AM
Two very quick points. I am a General Dentist. I graduated in the top of my class of the number one ranked school in the nation and could have gone to any "specialty" I wanted to. But I did not want to limit my practice. I have been doing endo for ten years now. I would put my treatment against any endodontist in the country. I feel that anyone doing this type of treatment should feel the same or stop doing it. I also feel good about most dentists trained with in the United States. I have no personal knowledge of the level of training a foreign dentist recieves, so we are comparing apples to oranges most of the time here. I also have been placing implants for the same length of time. Both areas of treatment have done well. I don't cut one for the success of the other. For the most part they have different indications. And as far as the "as long as gp's are doing crown and bridge", I have re-treated endo done by you guest it, an endodontist. Everyone is at risk of having bad results don't fool yourself.
Posted by: | Jul 19, 2006 5:37:01 AM
As a clinician who has performed endodontics and implant dentistry for over twenty years,I can honestly say that the availability of implants has NOT impacted the number of endodontic cases I do. In fact, implant dentistry serves as an adjunct to the services we provide. Vertical fractures, and poor cinical crown volumes have never reflected well in our success rates for long term retention of teeth. We give the patient a choice backed up with our experience performing both modalities. Most often, patients are choosing the implant option to treat very marginal cases. But we would never routinely sacrifice a viable tooth just to perform an implant procedure. If you choose endodontics, rest assured that you have a very promising future. If you plan on adding implant services, just remember it is a RESTORATIVE discipline first. If you are not willing to get training in prosthetic principles (whether or not you will ultimately restore the case), perhaps you should stick to your specialty.
Posted by: Robert J. Miller | Jul 22, 2006 2:08:53 PM
First of all, do what you love. Secondly, most endodontists I know hang a shingle and have instant patient flow.
True, I believe more and more patients ARE opting for implants as opposed to conventional endo. Nevertheless, even though endo does have it's pitfalls, there will always be a place for conventional treatment in the future.
Posted by: David Lambert | Jul 24, 2006 6:40:32 AM
The Society of Endodontists published a position paper stating the belief that Implant placement needs to become a part of the Endo practice. More and More GP's are doing Endo and Perio in house on many cases that should be referred out. In Perio, anti-microbial treatment from the GP's hygiene team has eliminated moderate perio case referrals. The added revenue from placement of these products does not hold up to the benefit the patient recieves. Most patients with a 7mm or deeper pocket need to be flapped. Laser companies are marketing to GP's with the CPT book and doing weekend courses on both Endo and Perio applications. Nobel, the most aggressive company with this push, has a mentoring program to teach GP's how to place implants. Usually led by a specialists former referral. Endo is being pushed at the edges because dentistry does not limit what the General Dentist is allowed to do with Patient Care unlike the medical profession. Do what you like but going in you should know that industry is trying to get more patients in implants through GP placement and pushing GP's to do their own Endo.
Posted by: | Jul 27, 2006 8:29:02 AM
I agree with Satish Joshi.
Speaking from personal experience, root canal is much safter than implant. I've had three root canals both have crowns that are 25 years old. Never any problems whatsoever. Unfortunately, I was dooped into a dental implant that turned out to be a nightmare. In pain 24/7, grafts, surgeries, exraction resulting in severe bone loss. and of course, my insurance would not pay for implant related health problems. Root canals, however, are almost covered in full. I do not believe implants are having an impact on root canals. If they are, it will be temporary as we begin to see more and more implant complicatons.
Posted by: Deborah Lesnoy | Aug 30, 2006 6:31:26 PM
As a profession we may place to low a value for tooth substance. We may be preparing too many teeth for full coverage and not considering other options consistant with the conservation of the bulk of the natural tooth at the cervical region. In addition, teeth are in a powerful sense sensory end organs which provide valued feedback to mandibular physiology as well as maintain the alveolar housing.
Honest disclosure to the patients regarding outcome assessment of whether to restore or extract for a better prognosis is essential. The patient must be party to the decision process. Things for us to consider when restorative antics are selected is the load capacity, or the ability of the tooth after endo, post core and crown lenghting and further reduction at the cervical for the ferrule will weaken the tooth perhaps even more. Where is the tooth in the arch? Cuspids and molars will take on more deformation under load and are functionally more at risk. The overall host reststance and the health of the patient as far as grafting and surgical placement, these and many other factors must be considered.
If you want endo go for it. The services that can be provided for our patients is wonderful
Posted by: SMS | Sep 2, 2006 2:18:07 PM
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