The case report by Drs. Brisman and Moses ("Implant Failures Associated With Asymptomatic Endodontically Treated Teeth," February JADA) is outrageous. Their conclusions are completely unsupported by their documentation and the literature they quote. Besides being 30-plus years old, [their information] must be significantly distorted to become relevant to their erroneous conclusions. We are appalled that a supposed "peer-reviewed" journal with the reputation of JADA could legitimize such misrepresentation of reality by publishing it.
A cursory review of the radiographs clearly indicates the implant failure is due to poor surgical placement and that there is no relationship to the endodontically treated teeth as stated. A more careful reading raises a multitude of questions that should have been asked in any peer-review process.
Was an endodontist consulted in any of the cases?
Where are the preoperative radiographs?
Were the purported "lesions of endodontic origin" present prior to implant placement?
What was the quality of implant surgery? In Figures 1 and 5, the implants appear to have been placed into the periodontal ligament of the adjacent teeth. Was the apical surgery (Figure 2) necessary? Was the lesion given a chance to heal following removal of the implant?
In Figure 4, where does the sinus tract originate? The gutta-percha cone simply tracts into the base of the surgical defect left by removal of the implant. It comes nowhere near the apex of the adjacent tooth, a tooth that appears to demonstrate an intact lamina dura apically.
The patient in Case 2 was apparently 93 years old at time of surgery (age 76 in 1980). Was this treatment prudent or a bit overzealous?
In Figure 6, isn’t that sinus-tracking instrument a Hedstrom file, not a gutta-percha cone as reported? How can you reliably trace a sinus tract with that technique? Regardless, the file still simply falls into the defect left by the failed implant, several millimeters from the apex of the adjacent tooth.
Is the radiolucency centered over the implant or the adjacent tooth? Again where is the pre-operative radiograph? The reported treatment of this lesion was with antibiotics and surgical débridement. It is highly unlikely that an endodontic lesion would resolve with that type of therapy.
The quoted literature does not support their position that microorganisms commonly remain in apical areas following endodontics. It does report the presence of chronic inflammatory changes but even those studies1,2 were done more than 30 years ago with techniques some would consider questionable today.
This poorly presented article is an attack on endodontics, a specialty with a well-documented record of success over many decades. As such this report should have been given very careful scrutiny before its release to the public. Unfortunately, it can’t be recalled and, again unfortunately, it will end up in the literature reviews of other unwarranted attacks on endodontics.
We hope in the future the editors of JADA will be more diligent in their peer-review process. Continued publication of reports such as these will lead JADA into the category of throwaway journals that now fill our mailboxes.
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