Page 8 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

increasing wish to retain natural teeth, along with the higher standard of care and

ethics among dentists, have allowed for the glowing return of endodontic treatment
into modern dentistry. This has given tens of thousands of diseased teeth another

chance of survival.

Treatment Success vs. Tooth Survival

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Dental implants have indeed changed the ecology of oral medicine in the 21
century. Different techniques and advancements in implant surgery have been taught

around the world, and well-known journals have been publishing the comparative
success rates of implants versus root canal treatments.

Experts in the field of endodontics have set strict standards to define a “successful”

root canal treatment long before the rise of implants. Subjectively, the previously
painful tooth should no longer cause any discomfort to the patient after completion of

treatment. Objectively, there should be a disappearance in sensitivity to percussion and

palpation, and improvement in tooth stability. Radiographically, one should see
healing of the radiolucent lesion, reformation of the lamina dura around the tooth, and

even increase in the alveolar bone height. These objective signs must also remain
unchanged for a defined period of time. If any of the above standards are not met, then

the root canal cannot be deemed successful. Such strict requirements for success were
originally intended to remind dentist to be mindful of every single step in a root canal

procedure. However, it is exactly these requirements that make root canal treatment

less appealing to inexperienced dentists, so they opt to complete simpler and less
daunting procedures for the sole purpose of maintaining tooth survival in the oral

cavity.
Many patients retain teeth that have been endodontically treated but have residual

lesions or vertical root fractures and are unwilling to remove or treat them. They often
report none to mild intermittent discomfort, and the teeth can function passably on a

day-to-day basis, so patients don’t see a need to intervene. Unbeknownst to them that

these mild discomfort or gingival swellings are indications of a current infection that
can blow up anytime. Therefore, if the only requirement for treatment is tooth

“survival” (as in, it’s still in the mouth), without any regards to the presence of any

pathology or infection, what becomes of our professional standards?

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