It has always been a goal of dentistry to replace teeth or broken/decayed parts of teeth with something that is as close to nature as possible. This is not only in terms of how the replacement looks, but how it functions and its longevity.
We know that people who have lost their teeth report a number of negative factors including:
- Loss of confidence
- Inability to accept changes in facial shape
- Limitations of food choices
- Reduced enjoyment of food
Some patients advise that they avoid laughing in public and also a reluctance to form close relationships.
Overall, the evidence suggests that loss of teeth impacts our quality of life.
Both Dr Kulkarni and myself share a passion for the profession and science of dentistry and recently discussed how dentistry has changed over the years – in particular, the saving and replacing of teeth.
Firstly, we note the belief by our patients “that tooth loss is inevitable” has changed and today more people try to save their teeth. Due to the advancement of dental implants and greater public awareness of this procedure, more people are now considering implants rather than the acceptance of lost teeth. There is also the belief by the public that implants are equal to natural teeth.
Due to improved treatment practices and other advancements, current data tells us that
the survival of Dental implants is similar to that of a natural tooth being preserved through Root canal therapy which is directed at preventing tooth loss for an infected tooth.
Since the survival is similar, the choice of treatment option is often based on other factors such as the risk of future decay or gum disease, the way teeth interdigitate, medication and medical history, oral hygiene, and the associated risk involved in each procedure in a particular individual.
So – what is the good and the bad of implants as opposed to retaining natural teeth with Root canal treatment?
We now know that in 1988, 65% of people between the age of 55-65 years wore partial dentures and in 2016 that percentage reduced to 29% who wore partial dentures for missing teeth. The statistics also suggest, complete loss of teeth for people ages between 56-90 was 47.2 in the year 2004-2006 and the prediction for the same is only 3% by the year 2021. (Dental Demographics and metrics of oral diseases in the ageing Australian Population. MS Hopcraft, ADJ 2015,60:(1Suppl):2-13) Clearly there is a trend towards more and more people retaining teeth and replacing missing teeth with other modalities rather than dentures.
Dental implants comprise a titanium screw that goes into the jawbone to support a crown, which is fabricated to look and function like a natural tooth. Implants (where indicated) can be considered as the best replacement for natural teeth because they return chewing capacity close to that of natural teeth. The cost could be a deterrent for some, and implants require regular maintenance and long term professional dental care.
Current evidence tells us that dental implants have a higher rate of minor complications (such as the implant crown becoming loose or coming off), as opposed to teeth retained post root canal treatment.
Despite this, the demand for implants is growing. As evidenced by a study done in the U.K that predicted in 2017 there was compound annual growth rate in demand for implants of 15.4%. (Implant Dentistry in General Practice Part1: Introduction; Ken Nicholson, Dental Update 2016; 43: 410-16)
With Dental implants, it can be challenging at times to make the crown restoration aesthetically look like a natural tooth, which is often much simpler after root canal treatment. However, not every root canal treated tooth requires a crown restoration. Additionally, we know that the prevalence of gum disease increases with age – and as we age, the prevalence of diabetes, obesity, stress, depression and arthritis also increases. Scientific studies have proven that all of the above can affect the likelihood of gum disease (JM Albandar 2018, J of Clinical Periodontology : 45 (Suppl 20): S171-S189).
As an ageing population in Australia this is something we need consider as to the benefit of the choice of implants as opposed to saving natural teeth with root canal therapy, especially as dental implants are not immune to gum disease and often behave worse than natural teeth when affected by it. Emerging evidence also suggests 50% of dental implants over their life will get gum disease. (Derks 2015 Journal of Clinical Periodontology)
Some implant patients have also advised they dislike metal placed inside the jawbone.
However, all cases are individual and it should always be a consideration to conserve what nature has given with preservation dentistry and not determine that dental implants are a perfect substitute for natural teeth.
If it does come to a stage where a tooth cannot be treated or restored back after root canal treatment or the treatment is associated with a high risk of failure, then leaving space can also be an option. Whether a missing tooth should be replaced is based on a number of factors such as any loss of function, any affect on aesthetics or any changes in inter-digitation of teeth assessed by a dentist over time. Studies suggest after a certain age, people can function adequately with a few missing teeth. (Is Shortened dental arch still a satisfactory option? M. ManolaBritish Dental Journal, 223, No.2: July 21 2017))
It’s important to remember that the best treatment approach is individualised to provide the best patient centred outcome and patient participation in treatment choice decision making is invaluable.
Finally, as the American Association of Endodontology states, Root canal treatment and implants should not be considered as competing options but should be viewed as complementary options.
If you would like to discuss your individual options, please call to arrange for a consultation.
Kush Ohri DENTIST
BDS, FRACDS (GDP)