Apicectomy vs dental implants – conserving teeth where possible
Featured Products Promotional FeaturesPosted by: Dental Design 27th September 2021
Dental implants are a fantastic treatment options for patients with failing dentition, restoring function, aesthetics and self-esteem. However, it’s important to appreciate that certain procedures may help to preserve some teeth, even if only for a few more years. Dr Irene Amrore is one of several ADI Webinar presenters to have created content for ADI members to access at their convenience, exploring this topic. With regards to her session, entitled “Apicectomy or Implant: Should We Delay Implant Placement?”, Irene offers an introduction …
There is some confusion surrounding when to choose an apicoectomy or implant treatment. This is, at least partly, because the procedure may not be in the undergraduate curriculum – though it would be taught as part of postgraduate training for surgical endodontics or oral surgery. Many dentists seem risk averse with an unwholesome fear of litigation, which is supported by findings from when I presented a few of my cases at one of the past ADI Members’ National Forums.
Another issue may be time constraints. The fast pace of NHS dentistry may not afford many clinicians the time to consider options that they might have otherwise evaluated if they had more time to spend with patients and provide the most conservative procedures.
A third and equally as important challenge for this decision-making process is that NHS dentistry does not always remunerate the dentist enough for the time spent on treatments such as apicoectomies. Based on conversations with colleagues, it appears that the remuneration provided through an NHS contract for such a procedure may not actually cover the costs of providing it to a high standard.
Putting these aspects aside, the following are the main criteria for selecting an apicoectomy:
- The tooth has to be stable or, if slightly mobile, likely to stabilise after the pathology is removed.
- After removing the pathology and apical portion of the root, what is left should be equal to or greater than the length of the clinical crown.
Where it is appropriate, an apicoectomy affords several key benefits. For example, it enables the clinician to conserve the natural tooth so that it might be kept by the patient for an unknown number of years. This, in turn, can delay the need for dental implants – a treatment that clinicians know is not without its own potential complications.
If I cannot save the tooth or am attempting to save a tooth with a hopeless prognosis, then the more suitable solution would be extraction and dental implant placement, if the patient is happy with this treatment. This approach facilitates the complete removal of pathology – i.e. the diseased tooth. For this reason, it has become the gold standard solution where teeth have a hopeless prognosis or are already lost, offering several benefits over alternatives like removable dentures.
I would always explain the two options of an apicoectomy or dental implant to patients using videos to help them understand the procedures, if I feel that saving a tooth is worth considering. To
I think it’s very easy as a clinician to get carried away placing dental implants and to forget that sometimes an apicoectomy could save a tooth. We just need to ask ourselves if there is any way of delaying dental implant placement until it is absolutely necessary. There are many teeth in many mouths that can’t be saved and definitely require dental implant placement, but some will be suitable for apicoectomies. It is a relatively simple procedure to learn for the experienced practitioner and there are many oral surgery courses that will teach the skills – plus there is always the referral pathway. Other clinical procedures that may also be useful in saving a tooth and delaying dental implant surgery include periodontal surgery to deal with one-wall defects, root resections and hemisections.
For anyone interested in finding out more, I have recorded a webinar on the topic available free to ADI members on the association’s website. I hope that colleagues will use the information explored to avoid extracting every tooth with apical pathology. Some teeth can be saved – if not for the remainder of the patient’s life, then for a few more years. It is still well worth the effort put in to conserve the tooth.
ADI members can access ADI Webinars for free. For more information about the ADI, or to join, please visit the website www.adi.org.uk
