The future of endodontics -Part II

June 1, 2002
In last month's column, we discussed the future of endodontics from a technical perspective. This month, we will discuss the future of endodontics from a philosophical basis.

By Dennis Brave, DDS
Kenneth Koch, DMD

In last month's column, we discussed the future of endodontics from a technical perspective. This month, we will discuss the future of endodontics from a philosophical basis. In particular, we will discuss the issue of implants vs. endodontic therapy, the status of endodontic education, and profitability.

The idea that implants will totally replace root-canal therapy is pure nonsense. Both are viable treatments. The key is to recognize which condition dictates a root canal and which suggests an implant. Implants replacing endodontics is an idea that principally comes from Europe. In many European countries, remuneration for endodontics is poor, but surgical fees are quite adequate. Consequently, European practitioners prefer implant dentistry (which provides a decent fee) to challenging root-canal cases with dramatically reduced fees. In other words, it's all about money. We don't want to be crass, but this column is a no-spin zone. Facts are just the facts.

Another aspect that contributes to this controversy is the quality of the average root canal performed in Europe vs. that of American practitioners. Certainly, there are talented dentists in every country, but, on average, root-canal therapy in the Unites States is superior to that performed overseas.

Well-done implants have a high success rate but so do well-done root canals. "Success" is difficult to define because a success rate depends upon the criteria. Consequently, one can manipulate success/failure rates to achieve the desired outcome. Don't get into a red-faced argument over implants vs. endo! Instead, recognize the indications and the limitations of both treatment options.

Endodontic education is another area undergoing significant change. We predict that graduate dentists will have more difficulty getting into endodontic programs. As programs become more attractive, they also will be more competitive. A number of schools are converting to "Graduate Medical Education Programs." Residents attend a post-doctoral program, receive a stipend, and pay no tuition. This is very significant. Instead of paying thousands for two years of study, they are receiving approximately $40,000 for each year of study. This can be a savings of up to $ 200,000! The increased demand, however, means that acceptance to post-doctoral programs in endodontics will become increasingly more difficult.

To make matters worse, some current endodontic programs will be closing in the near future. This is a direct result of faculty shortages. The AAE is addressing this concern with teaching grants, but the problem is still growing. Hopefully, new programs, such as the University of Missouri-Kansas City, will compensate for these closures. Nonetheless, the years ahead will be challenging for graduate endodontic education.

What about profitability? In the future, we see endodontics as a major revenue center for most practices. Due to the increasing number of endodontic cases, dentists who perform root-canal therapy will see a significant revenue increase. If clinicians take advantage of modern technology and learn to apply it skillfully, they will surely see an increase in their bottom line. However, dentists who insist on practicing the old way without rotary files or ultrasonics will find endodontics more frustrating - and far less profitable.

Our advice is to take comprehensive CE courses designed to truly educate, not just sell equipment. These should be broad-based courses that allow you the opportunity to try various techniques and systems from multiple companies. We have established our Real World Endo Institute to fulfill this need. Given "The Facts and Nothing but the Facts," it will be easy to capitalize on the next "Golden Age of Dentistry." We hope you are as excited about the future of endodontics as we are!

Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years.

Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at

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