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Root Canals vs. Implants podcast

 

 

 

Dr Ramzi Matar (Winter Park Dentistry): Hello everybody, thanks and welcome again to our podcast. Today I have a very exciting topic, it’s one that I think most every dentist deals with. The topic is how to choose between a dental implant or root canal, to save a tooth. And we have again our guest, Dr. Thao Le. I’ve got to tell people a little bit of insight as to why I’m so happy that you’re doing this with me. It’s because you trained, you did your specialty training in root canals at Harvard, so you’re obviously not very smart, and then after your three years learning how to do root canal specialties, you’re such a geek that you said “I want to spend two more years doing implants”. And I think you had some helpful guidance from one of my best friends, Dr. Peter Chen, who I think you know. And he said go in there, stick around and do it.

Here’s kind of the unique feature to that, that I think is important; I don’t know, personally, any specialists, at least here in my town, that have the unique skill set that you do, meaning that you not only can do a root canal and save a tooth, which a lot of people have faced this decision, or if the patient wants to take it out, you can take it out and do an implant. And so often times, if you’re with a specialist, and that specialist does all the surgery, whether he’d be a periodontist or an oral surgeon, they can only do the implants, they can only advise you on that aspect, versus if you go to a root canal specialist that doesn’t have the advanced training you do, well they can only do the root canal. So kind of have skin in the game.

Most people I know are pretty impartial, and are pretty fair, and they will recommend, even if it means not doing the surgery themselves, whatever the case may be, I don’t know that people are very malicious about it, but with that being said certainly when it comes to this topic, I think you’re an excellent expert on this, because the reality is anybody watching this, sometimes people are faced; they have a tooth that for one reason or another may need a root canal, the tooth has been broken, there’s not much tooth left, and the question is “well, gee, do I put money and effort and time into doing a root canal, and a post and a crown and all these other things” versus “well, I can take the tooth out and invest, usually a little more money, and do an implant that’s very very predictable, and success rates are in the high 90 percentage”. So, let me stop blabbing on. Please, let’s get into sort of how you help people, guide people into the decision skills of those two big dilemmas.

Dr. Thao Le: You know, I think that’s a very good question, I think it’s a question a lot of dentists have nowadays, do you go with the implant or do you go with trying to save the tooth and do the root canal therapy. It’s comes out to a number of factors; obviously finances is an issue too. Taking out a tooth, placing the dental implant, generally is a bit more costly than doing the root canal and placing an opposing porcelain crown. If you look at, in terms of what we could do in endodontics nowadays, for instance, if we were to look at a tooth and say the tooth had a root canal, and it needed re-treatment, we could easily re-treat the tooth, or if it needed to do an apical surgery, financially speaking, if you look at a re-treatment versus an apical surgery, and of an implant, it generally is more cost-effective than re-retreating it or even doing the apical surgery.

For instance, if the tooth required apical surgery, and that was a route, a decision that obviously a patient and I would have to discuss, the cost of that roughly, around here, in our area for an apical surgery, versus that of an implant, the surgery, the implant placement, the abutment for the implant, and the crown, could fluctuate from 3500 and above, in that respect, the cost of an implant could be a lost costlier, and the apical surgery is not what is used to be, where prognosis wasn’t so great.

Now that we have a better understanding, and using microscopes, and doing apical surgeries doing microsurgeries, we can easily treat the infections and the type of fill materials that we have for placing the materials that we use for apical surgery, that have improved significantly over the years, and our prognosis have increased to as high as 89% prognosis.

Dr Ramzi Matar (Winter Park Dentistry): So you’re going head-to-head with implants, almost. I mean, implants are in that 90%, now with newer technologies with some of these root canals, now you’re pretty close to that.

Dr. Thao Le: Yeah, exactly. But if you actually look at studies comparing the two, implants versus root canal therapy, they’re actually different criteria that they used to asses this, different parameters. So it’s very difficult to compare them side by side, because it’s kind of like comparing apples and oranges, they’re not exactly the same. But I could tell you from my experience so far, doing implants and root canals and doing apical surgeries and what not, they tend to be a lot more complications associated with implants, after treatment. Obviously it requires multiple surgeries, sometimes maybe bone grafting, sinus lifts and what not to place an implant, but the most severe complications that I generally see, have to do with the anterior region.

Let’s say you have a high smile, let’s say you have a front tooth, and you use either a root canal therapy or an implant, the problem that I see is that sometimes these teeth are taken out when they could be saved with conventional root canal therapy, or even apical surgery. And the side effect of taking out that front tooth, versus placing the implant, is that you tend to put a tooth at risk if you say, have a high smile. The problem is that, the papilla, which is the gums in between your teeth, it’s very difficult to maintain with implants. And the slight discrepancy of that would, say if you smile, and you see your gum line, it’s very unaesthetic.

Dr Ramzi Matar (Winter Park Dentistry): That’s the typical black triangle, and people hate that. They say “what’s this black thing in my teeth?”, and it’s not anything black, it’s the gums have receded and now you see through the gums, and it looks like a black triangle.

Dr. Thao Le: Exactly. So over the years, you may have some bone loss around implants. And actually if you look at studies, minor bone loss around implants is actually one of the successful criteria, but with natural teeth you don’t have that complication, those black triangles. And I’ve had patients come and ask how do we fix this, and it can be very difficult to fix, if you have a high aesthetic smile where your gum line is showing when you’re smiling. When you compare it with implants, survival, when you compare implants with root canal, survival if you look at the two is relatively the same. Comparing surgery, taking out a tooth, placing an implant, versus doing a root canal therapy, usually it’s a bit more basic to place an implant. So there’s a number of scenarios to take into consideration, but if it was my tooth, I’d do everything I can to try to save the tooth. But when you get to a questionable tooth then that’s something to discuss with your dentist, and also to consider the financial aspects of the two, if you want to save this tooth, with a questionable prognosis, or do you take out the tooth and place an implant.

Dr Ramzi Matar (Winter Park Dentistry): And so, just a little bit of a recap, in general, because we’re generalizing here, to do root canal, try to save a tooth, is usually less expensive. I can vouch for that, a root canal and a crown, even if you have to do a crown, you know it might be 2000 dollars, it’s nothing cheap, but an implant you’re talking 4000, 3000, it certainly is more. So if finances are an issue then a lot of times a root canal is a cheaper way of going.

If you’re in one of these borderline cases, just from what you were telling me, on upper front teeth, smiling teeth let’s say, you would fight harder for the root canal, because, and again, I’ve seen this and I’ve lived this, implants in the front, yes, they work, but they’re tough to make look natural. Teeth look blockier, you lose gums, you lose bone, and that’s natural for an implant, but you see it more on front teeth. And I agree with you there, teeth look like mushrooms, they don’t have that nice shape to them, they look more like triangular teeth, so I guess if somebody’s watching this video, and just based on these rudimentary criteria, if it’s a front tooth, you would say it’s quite a little harder.

Dr. Thao Le: If it comes to a natural tooth, I would probably do everything I can to save the natural tooth, because if you lose that natural tooth… Let’s say an implant fails, you place an implant and it fails, for you to re-do an implant every time it fails, you lose probably 20% chance of it succeeding a second time. Take out a tooth, place an implant, an implant doesn’t work, success generally was in the 90% range, for you to re-do that becomes a 70% success rate.

Dr Ramzi Matar (Winter Park Dentistry): The second time around. But that’s not the case on a root canal. Let’s say you had a root canal on a front tooth, twenty years later, we classically see this as trauma, you got hit as a kid, you had a root canal, twenty or thirty years later, the root canal is failing, the success rate is better, I assume it’s not 20% less.

Dr. Thao Le: Right, yes. For you to re-treat it, our retreatment success rates that we have, you’ll see that it’s in the range of 80-90%. Re-treatment. Apical surgery, probably in the same range.

Dr Ramzi Matar (Winter Park Dentistry): Still pretty good.

Dr. Thao Le: Still pretty good. I mean, it’s certainly a treatment round that works very effectively. Unfortunately sometimes people do come to us saying a root canal’s not working, it really depends on the kind of treatment that’s been done. Anyone could do a root canal, but if you cannot do it correctly, then it will not work out.

Dr Ramzi Matar (Winter Park Dentistry): So listen, I appreciate it. You know, sometimes, there are those outlines, there’s cases that are just not savable, and then you’ve got to do what you’ve got to do, but we’re trying to talk about the intermediate cases, when people have that selection, hopefully people learn something from this and say, even if it means just asking the extra few questions to the person, “what about this?”, because I think you can agree, for me the best patient is an educated patient who knows what they’re talking about, they ask me the right questions and I say “boy, this is so much easier, because we can discuss it”, and so hopefully a lot of people are watching this, I appreciate your time, Dr. Le, I think we’re going to have you on again, we have another episode with root canals, so you can get into that at the next episode. Thank you, everybody.