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Endo tips    Better Endo    Endo abstracts    Endo discussions

The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. - www.rxroots.com

Assessment of endoimplant algorithm

From: Terry Pannkuk
To: ROOTS
Sent: Tuesday, May 18, 2010 10:05 AM
Subject: [roots] The Endo Implant Algorithm Assessed

In the case attached I extracted a split maxillary second bicuspid 
with buccal perio bone loss and placed the implant in two stages.  
There are fierce opinions saying endo retreatment doesnít work,
bone needs to be protected at the expense of teeth, socket grafting 
should be done, immediate placement is better than two stage to protect 
tissue contours, platform switching is necessary to hold bone up
and prevent cupping, and yada yada yada.

In reality and regardless of what corporate shills say:

1.Native bone is king
2.Atraumatic extraction performed carefully with minimal forces on 
  the interseptal and buccal bone prevents socket collapse even 
  without foo foo.
3 Short implants in native bone are just as reliable if not more so 
  than a long implant placed in half foo foo/half real bone.
4 A little stable cupping of bone down to the first thread of an 
  implant is favored by many restorative dentists versus a narrow
  necked abutment placed in a platform switched implant holding up 
  bone but trapping food.
5 Saving the natural tooth if it is restorable protects the bone and 
  is worth a meticulous, skilled restorative effort.  Saving teeth 
  should usually be the first option if feasible.
6 Margaís Dutch saying, All advantages have disadvantages holds true 
  regardless of the big gorilla selling only the advantages.

No rotary file, no implant, no technique, no gadget, is perfect for 
all cases.

I got creamed on the Ankylos site for showing an implant I placed last 
week (placement preop plan and postop placement shown below).  
Comments were: it should have been Ankylos, itís subcrestal and
should have been supracrestal, you placed it too far buccal,  Ďif you 
were worried about the socket foo foo why didnít you call the clinican in 
Israel who placed instead of trying to nudge it toward the native bone on 
the buccal?,  more yada yada yada.  It was interesting to take a preimplant 
CBCT and todayís postimplant CBCT, comparing the significance of the 
compromises. I now have a baseline CBCT and can compare bone levels on 
all future recalls starting with next year like the recall I attached.
When someone says one product is better than all others, itís like a 
politician asking you to trust them.

There is massive confusion and misinformation regarding implantology, 
endodontics, and what we should really be doing clinically.  I view much 
of this confusion and bad science as being created by commercialism;
i.e those selling rotary files, those selling lasers, those selling 
graft products and those selling implant designs.

There are none among us that have all the answers but we should be 
asking the sources that deserve our trust.  Real scientists should be 
lecturing, teaching, and researching in the field of endodontics and
implantology, not gurus paid to be shills.   We should simply be shown 
the interesting and valuable new ideas produced by companies and
inventors, but the validation should be performed by those not having an
interest or stake in the profits, lecture income, or success.

Regarding the attached recall patient; it is not easy to answer the 
question: Would it have been better to fill the socket with fake bone, 
have questionable integration of the implant surface/threads yet have
a more plumped out buccal bone contour, or do it the way I did it with
no plumping and all native bone fill? For this guy my opinion is clear; 
on a supermodel with a big white smile, Iím not so sure.

Routine endodontic treatment is highly predictable and a great service 
to patients if done meticulously and with specialty level skills.  
Implantology is still just a new discipline looking for some discipline.
It is clearly the Wild West out there the problems with the science of 
implantology are even worse than the science of endodontics (in my opinion).
- Terry

K 3 lightspeed

Crown replacement

Root reinforcement

Vertical root fracture

Periodontal pocket

Cox crapification

Cold sensitivity

Buccal sinus

Nikon 995

Distal canals

Second mesial canal

Narrow escape

Membrane

Severe curvatures

Unusual resorption

Huge pulpstone

Molar access

Perforation repair

Maxillary molars

Protaper shaping

Pulsing pain

Apical periodontitis

Mesial middle

Isthmus protocol

Fragment beyond apex

Apical trifurcation

Jammed K file

Mesial canals

Irreversible pulpitis

Bicuspid abscess

Sideways molar

Red Dye allergy

Small mirrors

Calcified molar

Extraction and implants

Calcificated central

Internal resorption

Bone lucency

Porcelain inlay

Bone allograft