From the Editor
Gerard Kugel, DMD, MS, PhD
Last year, Inside Dentistry reported on the upswing of endodontics as both a specialty and a type of treatment offered increasingly by general practitioners. At the time, those we interviewed confirmed that while some would pit the treatment choices of endodontics against those of implants, the two treatment modalities are alternatives, not antagonists.
However, controversies seem to exist within our profession about whether or not endodontics or implants are the “better” choice, as if such a judgment call is prudent, universally applicable, or appropriate. It’s not. The questions are: “When is preserving a natural tooth via endodontics appropriate?” and “When should extraction and implant therapy be considered?”
Look at the Specific Case. The treatment that is truly appropriate may depend upon the case at hand. As our cover feature presentation suggests, there are many different clinical scenarios that can present with an endodontically needy tooth. The specifics of the individual case—as well as characteristics of the patient—will dictate treatment planning decisions and recommendations to ensure a successful long-term prognosis. Does the case involve a tooth that hasn’t undergone endodontic treatment previously, or will this be an endodontic retreat? What is the anticipated prognosis of the endodontic treatment (eg, guarded or marginal)? What is the patient’s periodontal status? Is the affected tooth restorable as is, or will crown lengthening be necessary?
Consider Team Tactics. Many cases involving endodontically compromised teeth do not have easy solutions. A great deal of time and attention, examination acuity, diagnostic skill, and treatment planning—not to mention technical skill—must be applied to every case. Frequently other members of the dental team—the endodontist, a periodontist, perhaps an oral surgeon, and of course, the patient—can provide invaluable insight into various aspects of the case so that an appropriate treatment decision can be reached.
Involve the Patient in the Process. Thorough and informed patient consent to any treatment is a requisite before performing any procedure. Patients need to understand their clinical situation and diagnosis. They then need to understand their treatment options, risks and benefits, and the consequences of doing nothing. Are there potential retreatment cycles that they may have to undergo if they select endodontic treatment? What is the total investment that would be required if they elect implant placement? Having that information is the only way they can make an informed decision about their care, one that is in their best interest based on their needs, financial means, and desires.
We hope you enjoy this issue and find that it enhances your ability to work collaboratively with endodontic and implant specialists when faced with the decision to try to save a tooth or place a substitute. We also hope that it enables you to better weigh your options when it comes to your choices.
Also, on behalf of everyone at Inside Dentistry, I’d like to take this opportunity to welcome Raymond L. Bertolotti, DDS, PhD, to the Editorial Advisory Board. An internationally renowned expert in adhesion dentistry, we are both pleased and grateful to have the benefit of Dr. Bertolotti’s wealth of knowledge and passion for his craft on the Board.
As always, we welcome your feedback, which you can send to www.insidedentistry.net. As I emphasize each month, your thoughts, opinions, and reactions motivate us to continually improve our clinical content and coverage of the topics impacting our profession. Thank you for reading and for your continued support.
With warm regards,
Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine
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