Colleagues Excellence

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Abstract

ENDODONTICS: Colleagues for Excellence 2 reservation of the natural dentition is the primary goal of dentistry. Published surveys indicate that patients generally value teeth and express a desire to save their natural dentition in favor of extraction whenever possible (1, 2). Significant technological and biological improvements have been made in all disciplines of dentistry, making long-term retention of natural teeth more attainable. Patients entrust dental professionals to make appropriate recommendations regarding the maintenance and restoration of their oral health and function. It is essential to employ an evidence-based, interdisciplinary approach that addresses the interests of the patient when determining the best possible course of treatment. In July 2014, the American Association of Endodontists, in collaboration with the American College of Prosthodontists and the American Academy of Periodontology, hosted a two-day Joint Symposium titled Teeth for a Lifetime: Interdisciplinary Evidence for Clinical Success. Approximately 375 general dentists and specialists assembled in Chicago to focus on preserving the natural dentition. The educational program included evidence-based presentations on advanced regenerative techniques, improvements in technology, minimally invasive restorative methods and best practices for interdisciplinary treatment planning. Dr. Alan Gluskin, chair of the 2014 Joint Symposium Planning Committee, concluded that the current evidence directs clinicians to consider saving the natural dentition as the first option when developing treatment plans. Dental implants are one of the most significant advancements in contemporary dentistry. This innovation has had profound effects on endodontic, periodontic and prosthodontic treatment planning for the rehabilitation of edentulous spaces and for teeth with an unfavorable prognosis (3). Implant-supported restorations minimize unnecessary preparation of intact abutment teeth and allow fixed prosthodontic replacement when suitable abutments are absent. With appropriate usage and case selection, implant dentistry provides a viable option for the replacement of missing teeth (4, 5). There has been an increasing trend towards replacing diseased teeth with dental implants. Often, an inadequate or inappropriate indication for tooth extraction has resulted in the removal of teeth that may have been salvageable (6). Teeth compromised by pulpal or periodontal disease have value and should not be extracted without thoroughly evaluating restorability and potential retention therapies (7). A recent systematic review published in the Journal of the American Dental Association highlights a key question: " Is the long-term survival rate of dental implants comparable to that of periodontally compromised natural teeth that are adequately treated and maintained? " (8). Nineteen studies with a follow-up period of at least 15 years were included in the analysis. The results show that implant survival rates do not exceed those of compromised but adequately treated and maintained teeth. These findings support other studies comparing long-term survival of implants and natural teeth (9, 10), providing an important message: periodontally compromised teeth can be retained with quality treatment and appropriate maintenance. Therefore, it may be advisable to postpone implant consideration for the periodontitis-susceptible patient to fully utilize and extend the capacity of the natural dentition (11). Treatment Planning Options A key focus of the Joint Symposium involved treatment planning decisions regarding endodontic treatment and implant therapy. Should a tooth with pulpal disease be retained with root canal treatment and restoration, or be extracted and replaced with an implant-supported restoration? This assessment involves a challenging and complex decision-making process that must be customized to suit the patient's needs and desires (12-14). The topic has received considerable attention in the literature, the media and at dental continuing education courses. Endodontic treatment and implant therapy should not be viewed as competing alternatives, rather as complementary treatment options for the appropriate patient situation (Figure 1). Root canal treatment is indicated for restorable, periodontally sound teeth with pulpal and/or apical pathosis. Endodontic treatment on teeth with nonrestorable crowns or teeth with severe periodontal conditions is contraindicated, and other options such as implant placement should be considered (15). When making treatment decisions, the clinician should consider factors including outcome assessment, local and systemic case-specific issues, costs, the patient's desires and needs, esthetics, potential adverse outcomes and ethical factors (16). P

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Diagnosis, E. (2013). Colleagues Excellence. Colleagues for Excellence, 2–8.

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