Beyond Implants: Rediscovering Our Roots

Dentistry stands at a crossroads, where the gleam of titanium implants casts a long shadow over the humble, yet resilient, natural tooth. Over the past two decades, implants have transformed restorative care, boasting 10-year survival rates of 93-97%. But in our enthusiasm for this modern marvel, have we begun to sideline the time-honored craft of saving teeth? My presentation at the upcoming Rocky Mountain Dental Convention, titled “Beyond Implants: Rediscovering Our Roots,” aims to integrate and reignite a passion for endodontic and restorative excellence. We will be examining both time tested and innovative strategies to preserve compromised teeth. We’ll uncover why maintaining natural dentition is still a pillar of patient-centered care. This is especially important for our patients constrained by budgets, health issues, or a desire to keep their original smiles intact.

Drawing from extensive clinical practice, this session will highlight how Restoratively Driven Endodontics can salvage seemingly doomed teeth, offering alternatives that are often more accessible and biologically harmonious. It’s not about rejecting implants; rather, it’s about expanding our toolkit to include robust preservation options, ensuring we don’t extract prematurely. As we delve into case studies and evidence-based techniques, attendees will gain practical tools to balance innovation with tradition, ultimately empowering better outcomes for diverse patient populations.

The Shifting Paradigm: Implants vs. Preservation

The surge in implant placements—projected to reach 5.7 million annually in the U.S. by 2026—reflects their undeniable popularity. Yet, this growth coincides with a 15-20% uptick in extractions of salvageable teeth, as noted in recent endodontic literature. Why the rush to replace? Endodontically treated teeth, when effectively managed, achieve 87-93% survival over 8-10 years, rivaling implants while preserving proprioception and bone integrity without invasive surgery. This predictability can be achieved with a straightforward and efficient treatment flow.

Financially, the disparity is stark. A comprehensive implant restoration—including extraction, bone grafting, possible sinus lift, and crown—can exceed $4,000-$10,000, dwarfing the $1000-$3500 for root canal treatment and restoration. For patients with financial constraints, maintaining a compromised tooth might be their only practical option.

Medically vulnerable individuals, such as those with osteoporosis on bisphosphonates or poorly controlled diabetes, face elevated complication risks with implants, including delayed healing or failure rates up to 20% higher. Moreover, patient surveys reveal overwhelming preference: 94% of adults prioritize retaining natural teeth as long as practical, citing emotional attachment and natural feel.

This return to preserving compromised teeth requires a restoratively driven mindset, where we evaluate teeth holistically before condemning them. By prioritizing preservation, we uphold ethical standards, reduce lifetime costs, and enhance satisfaction—studies show preserved teeth yield 10-15% higher long-term contentment scores than prosthetics. Furthermore, once a compromised tooth can no longer be maintained, then an implant can always be placed. Once a tooth is extracted and an implant is placed, future options become much more constrained and complicated.

Synergizing Innovation and Tradition in Practice

Tooth preservation thrives on blending innovative tools with proven methods. In the presentation, we’ll explore clinical cases that demonstrate this fusion, turning challenges like fractures and infections into predictable long-term triumphs. Many of these cases will push the envelope of what is thought possible.

Take a 76-year-old retiree with severe pain #30. Traditional radiographs suggested a near hopeless prognosis. CBCT revealed that aside from the deep distal caries, sufficient tooth structure remained to make treatment possible. Extraction was discussed as the most predictable option; however, the financial commitment was too large for her to overcome. Treatment was initiated with a full disassembly to verify restorability. A gingivoplasty was performed with a soft-tissue laser and a bonded pre-endo buildup was placed under perfect isolation. The canal system was debrided and disinfected using laser enhanced irrigation. The tooth was medicated and temporized. At the completion appointment, her symptoms had fully resolved. The soft tissue around the deep caries was completely healthy. The canal system was obturated and a surgical steel post was placed. Her restorative dentist was then able to place a well-adapted crown. This restoratively driven endodontic approach made a complicated clinical situation routine and predictable for her and her restorative dentist. Eight years on, the tooth is still asymptomatic and functional, sparing this patient thousands of dollars on an implant investment.

Forward Together: A Balanced Future in Dentistry

As dentistry evolves in our ability to replace teeth, let’s not forget our roots. “Beyond Implants” advocates for harmony in using implants where needed but championing preservation as the ethical default.

Dr. Rahim Karmali is a globally recognized clinical endodontist in Denver, CO.  He is dedicated to redefining excellence through a conservative, patient-centered approach.

References

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2.  Elani HW, Starr JR, Da Silva JD, Gallucci GO. Trends in Dental Implant Use in the U.S., 1999-2016, and Projections to 2026. J Dent Res. 2018;97(13):1424-1430.

3.  Grand View Research. Dental Implants Market Size, Share & Trends Analysis Report By Implant Type (Titanium, Zirconia), By Region (North America, Europe, Asia Pacific, Latin America, MEA), And Segment Forecasts, 2024 – 2030. 2024.

4.  American Association of Endodontists. Nationwide Consumer Survey on Oral Health and Natural Teeth. 2025.

5.  GoodRx Health. How Much Do Dental Implants Cost? 2024.

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7.  Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: