I read with interest "Implant Failures Associated With Asymptomatic Endodontically Treated Teeth" by Drs. David Brisman, Adam Brisman and Mark Moses (February JADA).
The article attributes implant failures in four specific cases that the authors associated with asymptomatic, endodontically treated teeth. I believe they do the science of endodontics a grave misjustice in attributing the described implant failures to past endodontic therapy. Examination of the radiographs that were included in the article reveals, in my opinion, a different clinical cause for lack of implant osseointegration.
In Case 1, the left implant clearly violates the periodontal ligament of the adjacent tooth. The implant did not integrate, nor would one expect it to. However, in the same case, when an implant was placed more appropriately relative to the adjacent tooth, that implant became osseointegrated as one would expect.
In Case 2, two implants were placed into the molar regions of a patient’s mandible. The distal implant integrated. The anterior implant did not. The implant that did not integrate is not, in my opinion, in close proximity to an endodontically treated tooth.
Under the best of circumstances, osseointegration occurs approximately 95 percent of the time in the human mandible. Unfortunately, that means approximately five percent of implants placed will fail. In many cases, the etiology cannot be ascertained.
In Case 3, an implant was placed again in close proximity, in violation of a periodontal ligament of an endodontically treated tooth. This implant failed to integrate. Again, in my opinion, I do not think it was related to the proximity of the endodontically treated tooth but was related to violation of the periodontal ligament of the natural tooth.
Case 4 is more obscure in relation to the quality of the radiograph (Figure 7). Figure 7 does not allow the reader to visualize the quality of the endodontic treatment on the mandibular premolar. However, Figure 8 does allow the reader to identify what apparently is successful endodontic therapy on the above premolar.
I believe [JADA] performed a disservice to the dental profession in general and the dental implant community specifically in publishing this article. I do not think the authors have proven their conclusion that asymptomatic, endodontically treated teeth are implicated in nonintegration of dental endosseous implants.
I encourage readers to regard the study’s conclusion with skepticism. I believe JADA’s reviewers need to be more attentive to conclusions that are not backed up by either scientific research or clinical follow-up.
