I DON’T THINK SO!!!!!!!!!!

Recent posting in Dr. Bicuspid referenced an article in August Journal of Endodontics wherein a preponderance of respondees in a survey replied that they would not refer to an endodontist to place implants……….In lieu of a comments reply, thought I’d go one better.

Dear Ms.

There were
two articles of interest in the JOE edition your reporter referenced in the
posting of the other day…….One reported that – Ninety-four percent of the GPs
had positive perceptions of endodontists, but they only referred 46% of patients
who required root canal treatment to endodontists, while in a survey sent to 1,500 randomly selected practicing general dentists
in the U.S., 66% said they were opposed to endodontists placing dental
, and as many as 73% indicated that they would not refer patients to an
endodontist for implant placement. The design of the latter article focuses on
respondee perception of skill, theirs and endodontists, and personal bias
evident in the subtext, a very dangerous thing to analyze; the scope of the
question needs to be expanded further to address who is driving implant
placement and why have endodontists seen this as a right of passage in their
service mix. 

The history of implant placement was based on territoriality from the
outset. Periodontists were refused entry to the club early on; prosthodontists
told to mind their business as well.  The
science of Implantology went through massive iterations from the era of a pier
at low tide to the ability to replace a tooth in the esthetic zone with almost
preternatural skill.  The question that
should be posed first and foremost is why this paradigm shift is occurring. The
answer is multivariate, but in the scope of this letter to the editor, I’d like
to address what I consider the primary factor. Market is driving science and
bottom lines are the sine qua non of an industry that should be evidence based
not eminence based.

Innovations in the endodontic armamentarium and the technical aspect of
the discipline have undergone mass iterative evolution over the past two
decades.  Unfortunately,guru driven
fiduciary aligned education became the modus operandi of the companies in order
to “sell”.  The bottom line of most of
the endodontic marketing campaigns could be subliminally read as “simplified”,anyone can do it. In a percentage of cases, that may be true, but the enormous
preponderance of endodontic treatment by specialty individuals shifted to
retreatment of primary therapy. Factor in the egregious decimation of residual
tooth structure by poorly designed post systems and sizes and you have an
invitation to disaster or implant replacement.

Endodontists should have always been party to the critical thinking and
comprehensive reasoning essential to the complexity of treatment planning.
Bridging the gap between the specialties should not have waited till 2011 to be
the concept behind the major endodontic meeting in North America. 
The endodontic periodontic implant algorithm
has been waiting in the wings for years; unfortunately, neither the major endodontic
houses world wide, or in North America in particular, nor the associations and
most of the post-doctoral programs saw the handwriting on the wall. With a free
and uncensored use of online forums and communities, they wouldn’t have needed
mailed surveys to ascertain the lay of the land.

The linkage of endo companies with implant companies is becoming de
rigeur, but they have failed to “bridge the gap” between their product silos
and as such, endodontics as a specialty is being diminished. When a pendulum
swings, its arc invariably reaches the full swing based on it’s dynamics unless
there is sufficient frictional resistance to adjust it’s path.  That friction was encumbent on the
associations and post-doctoral directors and the companies that financially
support their activities, their educational programming anon to deliver.  There is a horrific sense of lobbyists and
Lehman Brothers in the impact that single tooth replacement with implants is
having on endodontics as a science and a specialty and it needs to be addressed
and rectified sooner than later. What is currently happening in organized
dentistry seems fraught with a rearranging the deckchairs on the Titanic
mentality.  There is an enemy, sadly he
may be us. It’s time to speak up before there is nothing left to speak for.


 Kenneth S. Serota, DDS, MMSc


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