'dental implant'The rapid growth and success of dental implants over the last 20 years in this country has been quite remarkable. Something that was introduced as simply an overdenture discipline for edentulous patients has now become standard of care for single missing teeth. With any new rapidly progressing technology, especially in the health care field, the technology tends to proceed faster than the paradigm shifts in our thinking. Conventional treatment used to be dentures, bridgework, root resections and hemisectioning of teeth, and even tooth transplantation. Dental implants have become so predictable and so straightforward to restore that many of these previously mentioned treatments are no longer conventional. Many of our cherished ideas regarding the sanctity of teeth are being challenged by the success and predictability of dental implants.

In the past, when no other options existed, it was not uncommon to perform multiple endodontic procedures on teeth along with apicoectomy, post and core buildups, crown lengthening, splinting of ailing teeth to adjacent teeth, and any other number of measures to preserve the teeth as long as possible. Most major dental implant companies now have reported success rates of greater than 95% for their implants over five years. When comparing these success rates with the multiply endodontically treated tooth that is requiring further treatment, it becomes hard to justify heroic measures to save a single tooth.

Obviously, if a tooth is decayed and requires restoration and root canal therapy, that is entirely appropriate. But as we start looking at a tooth, its periodontal support, the amount of decay or endodontic involvement that might be present, and what would be involved in saving that tooth, one must now consider the predictability of these measures versus removal of the tooth and placement of a dental implant. The idea that teeth are sacrosanct is not written in stone. For example, we routinely remove perfectly healthy bicuspids for orthodontic purposes.

In summary, the “hard and fast” rules pertaining to appropriate measures for “saving a tooth” should now be reexamined on a case-by-case basis. Dental implants are no longer experimental, but rather have become standard of care. When faced with a badly ailing tooth where multiple dental and surgical procedures might need to be performed in order to preserve it, one must ask oneself the following questions:

  1. Are the “conventional treatments” more expensive than a dental implant over the short-term and long run?
  2. Which option is more cost effective over the short-term and the long run?
  3. Which option is the most time effective for the patient in terms of total chair time and number of office visits?

As we re-examine our treatment planning utilizing this new paradigm, it becomes clear that dental implants are often the “most conventional treatment”.