COLTENE’s Mark Allen asks: “When is endodontic treatment not an option?”
In recent years there has been some debate around whether extraction followed by implant therapy is more viable than endodontic treatment. Importantly, research has shown that both implants and root canal therapy demonstrate good success rates .
As such, it shouldn't be a question of one or the other. As long as the procedure has been ethically chosen based on clinical guidance, experience and the patient’s best interest, that’s all that matters. When implemented correctly, both treatment modalities can help to restore function, comfort and aesthetics. If one isn’t suitable then the other might be – as dental professionals know it’s a matter of assessing each individual case. Certainly, where possible it is always best to preserve the natural tooth, as long as the circumstances are right to do so.
Indeed, all teeth with pulpal or periapical pathology are candidates for root canal treatment. Only if the tooth can’t be saved and restored to full use should an alternative pathway be considered. Before ruling out endodontic therapy and condemning the natural tooth, the following questions should always be asked:
• Is there adequate access? If there is limited space or the patient has a small mouth it may not be possible to carry out root canal treatment.
• What’s the patient’s oral hygiene status? If the patient is unable to maintain an acceptable level of oral hygiene, endodontic treatment may not be appropriate.
• What is the patient’s general medical condition like? Where old age and/or poor physical health could compromise the treatment outcome, the pros and cons always need to be weighed up.
• Is the tooth supported? There must be sufficient bone and periodontal support in order for treatment to be viable.
• Is the tooth functional? Where a tooth is unopposed and non-functional, extraction may be the only option.
• Are there any root fractures? While it is widely believed that horizontal root fractures have a more favourable prognosis, vertical fractures will often require extraction.
In addition to these factors, practitioners need to consider any case-specific treatment challenges as well as the individual’s personal needs and preferences. One patient, for instance, might prefer to have the tooth extracted and replaced by an implant instead of undergoing root canal treatment, while another may want to avoid extraction at all costs. Interestingly, research suggests that a higher percentage of patients would actually rather opt for endodontic treatment and preserve their natural teeth than have them extracted and replaced with implants .
Clearly, both pathways have a place in the treatment of damaged or infected teeth. What’s important is that the appropriate procedure is chosen and delivered to a high standard. In the provision of root canal therapy, using effective techniques and reliable, high-performance products such as those available from global manufacturer COLTENE, will ensure that patients can hold onto their natural teeth for longer.
1] Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res. 2014;93(1):19–26. Accessed online December 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872851/
2] D. Re et al. Natural tooth preservation versus extraction and implant placement: patient preferences and analysis of the willingness to pay. British Dental Journal 222, 467 - 471 (2017). Accessed online December 2017 at http://www.nature.com/bdj/journal/v222/n6/full/sj.bdj.2017.271.html