PDF Download - Glidewell Dental Labs

DC: We often hear that endodontics is
pre-implant therapy. Do you share that
view?
DT: [Laughing] Not quite, no. As a
matter of fact, the person I lectured
with today is a great endodontist —
Dr. John West. We supposedly had a
head-to-head debate on endo versus
implants, but it’s not that way. Endo
is just one aspect of treating a tooth.
Great endodontists today have a 95 to
97 percent success rate. So, that’s not
the question. It’s not about the apex
— that’s about a 3 to 5 percent failure
rate — it’s about what’s left of the
natural tooth that becomes the real
treatment planning problem. You can
seal an apex, but what does the rest
of the tooth look like? Is the patient
prone to decay? Is the patient prone to
periodontal issues? Is the patient still
susceptible even though the apex was
sealed beautifully? Is the tooth strong
enough to withstand the occlusion?
What’s the fracture rate of posts in
general and the fracture rate of teeth?
So, I see it as what they call the “etiological
pile.” The pile builds up on
a given patient. If you have a patient
sitting in your chair, and the patient
is prone to periodontal disease, prone
to tooth decay, and they’re in your
chair because they have lost teeth and
are having problems in their mouth,
it’s not just whether the apex can
be sealed. Decay rate in five years
might cause a problem, certainly in
10 years. Post fractures, post loosenings,
debonding of teeth — all of these
things become an additional pile. And
if the patient has a few of these things
on their list, not just the apex of a
tooth being the problem, the pile suddenly
can become overwhelming and
you’re leaning toward an implant. So
it’s not endo versus implants. Some of
my best friends are endodontists!
DC: [Laughing] And your best referring
doctors, too?
DT: And my best referring doctors,
yes. We work very closely together.
But if they can’t save a tooth, we go to
an implant. But, clearly, for a lot of the
teeth that I used to treat endodontically
— hemisections and things like
that — I don’t need it anymore, other
than to hold a temporary while I
transition these patients out of those
teeth and put in implants. Long-term,
an implant is a far superior restoration
in our hands, and I’ve been doing
both. Being a periodontist and a
prosthodontist, I saved all those teeth
for so many years. I built my practice
on that originally. And if you ever
want a great lecture on furcations, I’ll
be glad to give it to you. But the reality
is that nobody wants to listen to that.
If I did a lecture today on furcations,
nobody would show up. Or if I did a
lecture today on implant esthetics versus
teeth — forget it.
In most people,
the crown on an
implant definitely
lasts longer than
the crown on a
tooth, especially
if the patient is
prone to decay
or periodontal
disease.
DC: How would you assess the state of
dental education on implants at the
university level today?
DT: I think it’s gotten a lot better.
When we first started with implants,
we realized this needed to be taught
more universally because the students
were not getting the right kind of
information. Some of them were just
getting lectures. There were six or
eight lectures they used to get back in
the 1980s, but nothing that was handson.
That was only for the grad students
— the prosthodontists, periodontists
and oral surgeons. So the general
dentists who were coming out of school
were totally untrained. And I really
mean untrained. They didn’t know
how to do it. So if a patient came to
one of these former students missing a
tooth and needing it replaced, and the
patient was their first since graduating
from dental school and opening their
own office, what was the new dentist
going to tell them?
DC: A bridge?
DT: If you’ve never even done one implant
restoration, then you’re going
to do a 3-unit bridge. Because that is
what you were trained to do in school.
But this has finally changed. Now it’s
a requirement to restore some missing
teeth with implants while in dental
school. Even if you’re not doing the
surgery, you should at least be able to
do the restoration. So it’s still minimal
compared to the number of patients,
and it’s more costly in general, although
not much more costly than a
three-unit bridge. Dental insurance is
just starting to cover implants, as you
know. But before that, people would
say, “Well, it’s the same price for a
3-unit bridge or a single implant.” But
the insurance didn’t cover the implant
part. They’d think, “Well, my insurance
will give me some money for the
3-unit bridge, so I’m going to have
to go that route.” So, they were still
cutting down perfectly good virgin
teeth to put 3-unit bridges on.
DC: What are your thoughts on training
general dentists at the undergraduate
level to place implants?
DT: This is a politically charged question
in some respects because it takes
the place of what an oral surgeon and
a periodontist want to do. Today, even
prosthodontists are being cross-trained
for certain easier cases. It is ethical
now in their code of responsibility to
get trained in simpler cases of placing
implants. Right now, many schools
– Implant Q&A: An Interview with Dr. Dennis Tarnow – 11