I had a great oppportunity to meet Professor Syngcuk Kim , the Louis I. Grossman Professor and Chairman of School of Dental Medicine, University of Pennsylvania during the FDI/MDA Scientific Conference in Kuala Lumpur Convention Centre last weekend. Professor Kim is well known and much respected in the world of endodontics and also the guru and pioneer in microsurgery and microendodontics. Despite his impressive credentials, I find him a very humble and down to earth person. It is wonderful to be able to share thoughts with him, especially when we have something in common, our passion in endodontics or root canal treatment.
During his lecture, he showed a slide of a 600,000 year old lower jaw of a human, which is found in a museum in Heidelberg, Germany, just to illustrate that human anatomy remained unchanged, the mandible has the exact same number of teeth. Pulp anatomy is almost the same as what we see today. What has improved is the dental technology and treatment techniques, so that our teeth remained in function for as long as possible and we can have a better quality of life.
A take home message that is worth mentioning is when he discussed the choice between these two dental treatments, implant or root canal treatment, an issue that has been much debated of late. I have the exact sentiments as Professor Kim when he said that there are a number of treatment options before we dentist decide to remove a tooth and put an implant in the jawbone. He was not implying that implant was no good, but what he was saying was there were many teeth that could be saved and need not be extracted. The survival or success rate of a tooth with root canal treatment is similar to an implant. However, root canal treatment has been proven to have a long term success.
When my patient is presented with a decayed or carious tooth with an infected pulp, I will advise him or her accordingly whether the tooth can be restored by doing a root canal treatment or not. A common question asked by my patients is how long will the tooth last? I can only give statistics on success rate quoted from research articles but we dentist are not superhuman, so we honestly do not know and can only give an estimate.
Unfortunately, a small percentage of root treated teeth can become infected, due to either an old problem (i.e. root canals not properly cleaned and are still infected) or a new problem (i.e. leakage from the filling leading to reinfection). I will be able to access the condition and may recommend either retreatment (treating root canals a second time) or an apical surgery (oral surgery to remove the infected root tip of the tooth), if the tooth is still restorable.
When all fails, replacing the tooth with an implant is still an option.
