'Demythifying' the endo/implant controversy

(This is the first part of a CDA Presents Speaker Spotlight series highlighting the various topics that will be covered at CDA Presents in Anaheim.)

CDA Presents the Art and Science of Dentistry in Anaheim is expected to attract more than 25,000 attendees April 30-May 2, and one of the biggest draws is the unique lineup for lectures and workshops.

CDA Update staff spoke with Timothy Donley, DDS, MSD, who maintains a private periodontics and implantology practice in Bowling Green, Ky., and is speaking on several topics at CDA Presents in Anaheim, which will be held at the Anaheim Convention Center. Donley will be part of a panel discussion about the "Endo/Implant Controversy" and lead lectures on the oral-systemic link and nutrition and host modulation.

Donley has practiced dentistry for 29 years and says he enjoys implantology because he is able to perform "miracles by creating teeth growing out of the jaw where there are no roots."

Below are excerpts from the interview.

Let's get into the panel discussion you are going to be part of, "Demythifying the Endo/Implant Controversy." (Speakers also on the panel: Frank T. Curry, DDS, Alex Fleury, DDS, MS, Bryan Harris, DMD, Saj Jivraj, DDS, BDS, MSEd, and Hooman Zarrinkelk, DDS.) Why do you think there is confusion about whether to save a natural tooth with endodontics or place an implant?

We have had very few conversations in dentistry about the cost-effectiveness of the care that we provide. As the economic screws continue to tighten for our patients, we have to make sure that the treatment that we provide is worth it over the long haul for our patients. We have to decide what the ultimate goal of dental therapy is in today's world. We then have to determine which treatments allow us to give the patient the best chance of achieving that goal. I am looking forward to starting that discussion so that we all can further our clinical judgment.

Talk about how competing literature creates problems with long-term prognosis and retention rates.

With the ever-increasing capacity of the information superhighway you can now find an article to support almost any viewpoint. Dentistry is at an interesting point where the quality of the research must be evaluated before determining if that data should impact one's clinical approach. Clinicians need to further hone their skills in evaluating the literature.

Do dentists need to provide more information on risks, options and benefits to patients to help them make a valid decision on treatment?

It is all about the standard of care. Treatment must meet the standard of care. Generally speaking, to meet the standard of care the treatment that is rendered must be "reasonable." What is reasonable in today's world is to make sure that patients understand the treatment, alternatives, risks and benefits of suggested care.

The panel is going to delve into all of this as well as how to develop a treatment plan for endodontic treatment versus implant replacement of a compromised tooth. What is that going to look like?

I am looking forward to a lively discussion. I have found that the best way to refine my clinical judgment is to consider viewpoints that are inconsistent with my own. I suspect that everyone in attendance will leave with a better sense of not only when implants should be considered over endo therapy, but also with a clearer idea of how to make these decisions on a patient-by-patient basis.

What are the cosmetic, periodontal and functional outcomes and shortfalls of these two options?

During the panel discussion we will identify all of the parameters that must be considered when determining implants versus endo. Cosmetic, periodontal, functional outcomes along with cost/benefit, psychological factors, time and effort involved and expected life are factors that will be on the list.

Another one of your lectures is titled "How to Use the Oral-Systemic Link to Help Your Patients and Your Practice." Talk about how there is a lack of clarity out there in the profession about what can be said about the links between perio disease and heart disease, diabetes, low birth weight, arthritis, obesity, etc.

People get frustrated when emerging research comes to conflicting conclusions. We'll try to provide more clarity as to what we can say for sure about links between oral and overall health. We will clear up all of that confusion during the course. We will look at up-to-the-minute evidence with a deliberate attempt to package that research in a reasonable way to benefit our patients and our practices. There are powerful messages that can and should be delivered to our patients.

What is the risk-based approach to periodontal diagnosis and treatment that you will present?

There are patients who are more likely to get periodontal disease and there are patients for whom it is more important to avoid periodontal disease. It seems prudent to identify these patients and use that risk information to determine the level of treatment aggressiveness and to motivate patients. I will present a program that makes it easy to do just that.

Lastly, you have a lecture titled "Nutrition and Host Modulation for Better Perio Outcomes: An Approach That Can Change Lives." What nutritional and lifestyle changes will you discuss that can help make an immediate difference in a patient's oral and overall health?

A preferred level of overall health is all about keeping inflammation to a minimum. There are now specific nutritional strategies that can have measurable inflammation reduction effects. We will discuss specific recommendations concerning carbohydrates, fats, antioxidants and flavanoids that can improve periodontal outcomes. This information can help you change your patients' lives for the better. It might even help you make positive health changes in your own life!

What is the in-office system that can be used to identify patients who can benefit from host modulation and/or nutritional therapy?

It is all about identifying specific factors in patients that suggest that an exaggerated host response is at work. We will discuss what these factors are, how to easily identify affected patients and what to do about it!

For more information about CDA Presents, visit cdapresents.com.

Topics: CDA Presents