Oral Health Group

Letter to the Editor

July 3, 2018
by Dr. Philip M. Walton, DDS, MMSc, FRCD(C) US Board Certified, Diplomate of Periodontics

Re: May 2018 Oral Health Editorial

I’m always a tad confused with this supposed popular topic in dentistry today…


Since when did it become Endo versus Implants? Doesn’t versus imply against each other?

Perhaps I’m in the minority but for me, if a patient needs a root canal, they need a root canal. And if a patient needs an implant, they need an implant.

In cases of questionable teeth, it really becomes a decision of whether the tooth is not only amenable to root canal therapy, but more importantly is there adequate sound structure/ferrule to deem it restorable.

Although implants are a fantastic treatment modality, they are after all a prosthetic/replacement for one’s tooth and not the same as a natural tooth. Contrary to former beliefs, we know that implants are indeed imperfect and can be fraught with potential issues and require care and maintenance as Dr. Glassman mentioned in his article. I am consistently reinforcing the aforementioned to all my potential implant patients.

As a “younger” Periodontist I have commonly found myself amidst casual jokes from dentists suggesting all we want to do “these days” is rip out teeth and place implants because it’s easy and financially beneficial. I personally, would always opt for attempting root canals, crown lengthening or periodontal disease control/surgical procedures as a first line of therapy prior to extracting teeth in favour of implants. We always have implants as a backup down the road.

In fact – my best friend who is an Endodontist consistently curses me for wasting his time with cases that I have deemed worthy of consultation for maintaining the tooth via root canal. Almost 100% of the time he feels Endodontic intervention would not be efficacious.

Call me old fashioned and perhaps contrary to popular belief, but provided the patient is motivated – I strongly prefer they maintain their natural tooth – and if this so happens to involve endodontic therapy to achieve this goal – then great.

So, is it really Endo vs Implants? Or is it Endo and Implants? I think there is plenty of both to go around for all. OH

Dear Dr. Walton,

Thank for your insightful letter to the editor.

You’re are quite right. Every case should be evaluated on its own merits and certainly both implants and endo have a place in modern dentistry.

As Abraham Maslow said in 1966, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

With limited tools, treatment is often inappropriately advised!

Properly trained dentists in diagnosis and treatment planning will provide the patient with the best possible solutions for the most predictably successful outcomes.

Kind Regards,
Dr. Gary Glassman
Endodontic Editor, Oral Health Journal