Endodontic (root canal) treatment-resection or dental implants?

Undeniably, our utmost priority should be keeping our natural teeth in the oral cavity and their extraction should take place only when every attempt that has been made to save them has been unsuccessful.

During the recent years in Greece, with the financial crisis,  there is a shift of the opinion of Greeks in their attempt to find a way to preserve their natural teeth, so that the cost of dental treatment is reduced. In the past, and due to the economic prosperity that allows for easy and effortless solutions, dental patients preferred to sacrifice a tooth that could be saved if they visited an endodontist, so that the root canal treatment (resection) or even an endodontic surgical operation-apicoectomy could be successfully performed, in order to save, as the patients erroneously believed, cost, time, effort, and avoid trouble.

The patients now ask, read, get informed, so that they can ensure the health of their natural teeth, as well as restore, in any possible way, possibly wrong treatments that have been performed and could lead to a tooth extraction.

Nowadays, the constant education, the fully advanced technological equipment (microscopes and special machines, instruments & tools the endodontist uses), the highly trained human resources in science and the care for patients and their specific needs, make even the impossible seem possible! Damaged teeth due to improper endodontic treatments (root canals), with broken pieces of instruments within the roots, with fistulas with pus discharge and large pockets that are accompanied by tooth mobility can be saved, and their extraction can be avoided. Root canal treatment is performed again in the “doomed” teeth, the broken pieces of instruments are removed from the interior of teeth with the aid of microscopes with very high magnification capacity, curettage is performed to fistulas and pockets, apicoectomies or/and excisions of one or more roots are performed in the molars, so that their extraction is avoided, with an economic benefit for the patient.

Endodontic (root canal) treatment (resection), is completed, in most of the cases, in one single session and is painless and consists a less expensive solution than dental implants, that require the extraction of the tooth, a 3-4 month waiting period so that the post-extraction socket (alveolus) is healed, the subsequent placement of the implants, and a waiting period of 2-3 months in order to achieve osseointegration, and again, the exposure of the implants so that the final impressions are taken, for the construction of the prosthetic part.

Nevertheless, when the extraction of the tooth is the only way, the solution of restoration of edentulism with dental implants consists the most reliable solution with excellent standards for a long lasting result.


How and when did the procedure of implants began in dentistry?

Looking back in the history of dental implants, we will find out that implants, as we know them today, are used since 1965, when they have been accidentally discovered by the Swedish scientist Branemark.  More particularly, in 1952, he tried to construct a screw that could be easily removed in order to restore fractures in all of the bones of the human body. However, when he tried to remove the screw from the bone it was impossible, due to the complete osseointegration that had taken place. This was the beginning of many years of research and testing, until 1965, when the first application of dental implants that were specially designed so that they simulate the root of the tooth, took place.


What is an implant?

In dental terms, by the words implant or dental implant, we mean an artificial tooth root made of various metals or other biocompatible materials, which is placed in the bone of the jaws in order to support a tooth, bridge, partial or complete denture. They are more usually made of titanium, a biocompatible metal which has been used for many years in orthopedics for the reduction of fractures. Now, the alternative solution for the partial or complete edentulism of patients exists and does not consist an experimental solution but a solution which is reliable, sound and feasible, with excellent standards for a long lasting result.


What does a dental implant consist of?

Initially we must learn the parts of a tooth so that we can understand their corresponding parts of an implant. The natural tooth consists of the crown and the root. The crown is the part of the tooth that is visible in the mouth and is located above the line of the gums, while the root is not visible in the mouth, as it is located underneath the line of the gums within the bone of the jaw.

In order to describe the dental implant, we must know that it consists of three parts instead of two parts, as in the case of a natural tooth. These three parts are the dental implant itself which is placed in the bone of the jaw and replaces the root, an abutment which connects the implant with the third part which is the crown, that replaces the aforementioned natural crown of the tooth.


When are dental implants used?

The loss of a natural tooth due to dental caries, periodontal disease, injury or age, requires the immediate restoration of the area of edentulism with the use of a dental implant, so that the health of the adjacent teeth as well as of the surrounding soft tissues is also protected.

Dental implants can specifically be used

  • Firstly, when only one tooth is missing. Thus the dental drilling of the adjacent healthy teeth, so that they can consist the lateral supports of a bridge, is avoided.
  • Secondly, when more than one teeth are missing, and thus, apart from bridges, partial dentures are also avoided, which consist removable prostheses (that is, they are placed in the mouth and removed by the patient himself/herself and have a reduced attachment and stability). Furthermore, with removable prosthetic works (partial or complete dentures) there is a difficulty in chewing as well as in speech, that will eventually contribute to the social isolation of patients due to their aesthetic and functional deficiency.
  • Thirdly, implants can be used when all of the natural teeth are missing, instead of the use of complete removable dentures with all their aforementioned disadvantages.

What are the advantages of dental implants?

  1. Protection of the adjacent teeth, tooth sockets (alveoli), dental tissues, as there is no requirement of dental drilling in order to restore the missing tooth.
  2. The height of the alveolar bone at the sockets of the missing teeth is preserved, due to the osseointegration of the implant.
  3. Good aesthetics, as they are perfect copies of the natural tooth, while the border of soft tissues (gums) that surround the implants is also preserved.
  4. Excellent chewing capacity, avoiding the instability of the removable prosthetic works.
  5. Long-term solution which has totally predictable results.
  6. Over time, dental implants consist the most economical solution compared to bridges and partial or complete dentures, which might need to be replaced over time.
  7. Easy speech and articulation, restoration of the shape of the face, therefore a boost for the patient’s self-confidence.

What are the disadvantages of dental implants?

The only disadvantage of dental implants are the waiting periods during the restoration of edentulism (approximately 2-3 months). These waiting periods are deemed necessary so that osseointegration can be achieved before the implants are loaded with the prosthetic part, so that they consist a uniform and fully stable mass with the jaw bone. This can be also performed by a dentist who is a specialist in dental implants, based on clinical and radiological data as well as on the health history of the patient who is a candidate for implants.

One further disadvantage is their cost. One could say this is relative, taking into account that dental implants are a totally predictable and long-term solution, as they do not need to be replaced over time.


What is the proper medical evaluation for patients who are candidate for dental implants?

A prerequisite for the success of osseointegrated implants is the proper evaluation of the patient’s health as well as of the health of his/her oral cavity. And this is necessary because some pathological conditions may possibly affect the successful outcome of the surgical operation.

Thus, the factors that should be also taken into account in the evaluation of the patient are:

  1. Age, principally due to the development of various diseases and to the use of medicines.
  2. The patient’s sex does not play a particular part, but in the treatment planning attention should be paid to a possible pregnancy or to the existence of metabolic bone diseases, such as osteoporosis that principally affects women.
  3. The metabolic bone diseases, such as osteoporosis, accelerate the alveolar bone absorption in edentulous patients.
  4. Metabolic diseases that are due to hormonal disruptions. For example, fibrous dysplasia and osteitis deformans or Paget’s disease consist total contraindications for the placement of dental implants. Furthermore, diabetes mellitus does not consist a contraindication if it is controlled.
  5. The radiation of the jaw bones, due to the risk of osteonecrosis, if the surgical operation for the placement of dental implants is not performed under certain conditions.
  6. The use of medicines and principally of immunosuppressors consists a total contraindication.
  7. Smoking must be limited, particularly on the day of placement of the dental implants as it is accompanied by reduced healing ability and reduced resistance to inflammation.

What is the procedure of placement of dental implants?

Before the placement of the implants a diagnostic appointment shall take place with the dentist-dental implant specialist, in which the treatment planning shall take place based on a special X-ray, the dental CT scan. In this session the date and time of operation is decided, the exact positions of placement of the implants are set, based on the anatomy of the area and its specific requirements and the number of implants and the dimensions of each implant are defined.

The placement procedure that will follow is quite simple and incredibly fast. Initially the anesthesia of the area takes place, which is similar to the anesthesia that is performed before the extraction of a tooth and not something different. This is followed by the placement of implants by the dental specialist and their covering by the gums, which are stitched, in order to be protected, so that osseointegration is achieved, that is the full connection of the implant with the surrounding bone.

In a second stage, the exposure of the implants is performed, after approximately 6 months in the case of implants in the upper jaw, or approximately 3 months in the lower jaw. In this operation anesthesia of the area takes place once again, the implants are exposed and the healing caps are placed on them. After approximately two weeks and after good oral hygiene practices have been strictly observed and the mucosa around the implants has completely healed, the stage of prosthetic restoration shall begin, in which the impressions for the prosthetic part with which the implants shall be loaded are taken.

 Constantinos Laghios, Dental Surgeon - Endodontist, M.S. - Ioanna Tsangaraki, Dental Surgeon.

Molar with large lesion close to the nerve. Extraction and implants were advised to the patient.

   Root canal treatment was performed in one visit

The 16 years recall shows perfect healing!!!

Tooth with huge lesion: Extraction, placement of bone graft and subsequently implant had been advised by a specialist

Root canal treatment with incision of the abscess was done. Eleven months recall shows complete bone healing