Endodontists Not Likely to Get Implant Referrals

Laird Harrison

September 01, 2011

September 1, 2011 — General dentists will refer patients to endodontists for a lot of reasons, but implant placement is not likely to be among them, according to a pair of surveys recently published in the Journal of Endodontics.

The first study, published online August 1, found that only 33.8% of general dentists believe endodontists should place implants.

The finding comes against a backdrop of controversy about when implants should be placed, and who is most qualified to place them. As implants have improved, some patients who would once have opted for root canal therapy are now choosing implants instead.

"I think the specialty of endodontics is seriously considering implants," Michelle R. McQuistan, DDS, assistant professor of dentistry at the University of Iowa, Iowa City, and coauthor of the study, told Medscape Medical News.

Dr. McQuistan and colleagues mailed a survey to 1500 general dentists, of whom 366 responded.

Dr. McQuistan also was coauthor of an earlier study published July 2009 in the same journal, which found that 57% of endodontists think they should be able to place implants.

"It's really interesting that the majority of endodontists thought that it's OK for endodontists to place implants, but the majority of general dentists did not," she said.

More and more endodontists are getting trained in implant placement, according to an interview the American Association of Endodontists released in response to the August study. At this time, 7% of the association members place implants, and 16% plan to place them in the future, said James C. Kulild, DDS, the president-elect of the American Association of Endodontists, in an interview.

They are getting the training both as part of their specialty education and in courses offered by implant companies, he said.

However, the fact that relatively few endodontists have gotten into implants so far may explain why general dentists do not think of referring implant patients to them, Dr. McQuistan said. "Also, general dentists may be anticipating placing implants themselves," she said.

Kim Gowey, DDS, a general dentist and past president of the American Academy of Implant Dentistry, told Medscape Medical News that anyone who gets the proper training should be allowed to place implants. However, he questioned whether endodontists are best qualified. "Their surgical scope is much less than periodontists or oral surgeons," he said. "I'm not sure why they want to be in the implant area, except for financial reasons."

Dr. McQuistan said she does not think endodontists are pursuing implants because fewer teeth are being restored. She said a third of endodontists have experienced a loss of business in recent times, but a third have experienced a gain, and a third are holding steady.

The main reasons most endodontists do implants is as a service to patients who might want to work with fewer practitioners, according to Dr. Kulild.

Dr. Gowey is certified both by the American Academy of Implant Dentistry and by the American Board of Oral Implantology. However, these credentials are not recognized by the American Dental Association, and any dentist can legally place implants, he said.

So when do general dentists refer patients to endodontists? Another study, published in the September issue of the Journal of Endodontics, found that general dentists refer about 46% of patients needing root canals to endodontists.

Endodontists were most likely to get referrals from general practitioners if they followed up reports and images in a timely way, referred patients back for restorations, and accommodated patients' schedules, the survey found.

The July and August studies were funded by grants from Delta Dental of Iowa. The authors of the 3 studies have disclosed no relevant financial relationships.

J Endod. 2011;37:1191-1196. Abstract

J Endod. 2009;35:966-970. Abstract

J Endod. Published online August 1, 2011. Abstract

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