Often a badly broken-down tooth can be saved with root canal treatment rather than being lost forever to extraction. That way, you get to keep your own tooth – always the best solution from a dental perspective. Not only that; compared with teeth replacement, root canal therapy usually costs less. However, while the success rate for teeth replacement is close to 100%, the success rate for root canal treatment ranges between 80% and 98%.
If your dentist suggests pulling out one or more of your teeth and having dental implants instead, you may wish to seek a second opinion from a root canal specialist, known as an endodontist. An endodontist can root-treat a tooth, re-treat a failed root canal, seal up internal cracks, repair internal perforations, remove old posts and fractured files and carry out minor root surgery – and can often save teeth that are deemed “hopeless”. These practitioners have a Masters degree or equivalent in the field of endodontics and are registered with the Dental Board of Australia as specialist endodontists. They work using microscopes the size of your family fridge and look down root canals all day long. So seeking their opinion is often a good idea before a tooth is extracted.
If you opt for an extraction and dental implant, bear in mind that an implant crown is usually made up of two separate procedures: a surgical component (titanium fixture in bone) and a prosthodontic component (porcelain tooth placed on the implant). No one dental speciality recognised by the Dental Board of Australia covers both components; hence no one can claim to be an implant specialist.
However, when it comes to implant surgery, there are currently four kinds of clinician who typically perform this procedure: oral & maxillofacial surgeon (approximately 15 to 16 years’ training) – a board-registered specialist in the field of surgery to do with the mouth and jaws with degrees in dentistry, medicine and oral surgery; oral surgeon (approximately 8 to 9 years’ training) – a board-registered specialist in the field of surgery who has not completed a degree in medicine and has had a more limited surgical training phase; periodontist (approximately 7 to 8 years’ training) – a board-registered specialist in the field of dental bone support and gum surgery usually with a Masters degree in periodontic; general dentist (approximately 4 to 5 years’ training) – a non specialist whose training is not specific to surgery but covers all facets of general dentistry.
When it comes to crowns for dental implants, there are two kinds of clinician who typically perform this procedure: a prosthodontist – a board-registered specialist in the field of dental crowns and bridges and implant crowns and bridges with a Masters degree in prosthodontics (average training 3 to 4 years after becoming a dentist); and a general dentist – a clinician who may refer to themselves as an implant dentist or implantologist and cannot be rated by their specialist training in the prosthodontic field.
The general rule of thumb is: the more complicated the dental implants surgical procedure (especially if there is limited natural bone and there is need for bone grafts and sinus lifts), the more strongly advised you are to consult a board-registered specialist with formal surgical training, or at least seek their second opinion before embarking on such a course of treatment; and the more complicated the implant crown procedure (especially if there is multiple missing teeth, cosmetic challenges with the tooth, bite complications and jaw problems), the more strongly advised you are to consult a specialist prosthodontist or seek their second opinion before embarking on such a course of treatment.
Some other things to note:
- You do not need a referral to seek the opinion of any of the dental specialists mentioned here.
- There is no shame associated with getting a second opinion, and most general dentists will offer you a referral to various specialists, particularly if you ask. All copies of your X-rays and records, including study models, can be transferred to another clinician should you wish to seek a second opinion.
- Some general dentists will do both the surgical and prosthodontic components of your implant crown. Most specialists in either faculty – surgery, or crown and bridge – will team up with either another specialist or the referring general dentist to complete the two stages of this procedure.
- If in doubt about the formal qualification of any clinician in Australia, please visit the official website of the Australian Health Practitioner Regulation Agency (AHPRA) at www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx. Never assume the status of a clinician as a “specialist” in any field because of their reputation, position or profile within a practice, or based on marketing information. A “specialist interest”, as it is often termed on dentists’ websites, does not always equate to being a “specialist” registered by the Dental Board of Australia.