Description

Should we be doing more to save questionable teeth?

What if you could buy more time — without compromising patient care?

Dr. Omar Ikram returns for a powerful episode diving into the real-world decision-making between endodontics and implants. Together with Jaz, they explore tough scenarios — like teeth with nasty cracks or minimal remaining structure — and ask the critical question: when is it truly time to extract?

They break down concepts like retained roots, root burial, amputation, and a new term Jaz introduces — palliative endodontics. Because sometimes the best outcome isn’t immediate replacement, but smart, strategic delay.

Protrusive Dental Pearl: When discussing treatment longevity with older patients, tailor your language to be more relatable. Instead of saying, “I plan my dentistry to age 100,” say, “I want this to last well into your eighties or nineties.” This makes the conversation more personal and realistic, helping patients better connect with the concept of long-term outcomes.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

• Understanding the limitations of implants compared to natural teeth is vital.
• Medical history significantly impacts dental treatment decisions.
• Managing patient expectations is crucial for satisfaction.
• Palliative endodontics can provide temporary relief and management.
• Reading and interpreting CBCT scans requires skill and experience. If it’s not that five millimeter defect, it’s up to you.
• The second molar is a good one because often second molars can’t be replaced with an implant.
• Retaining roots is definitely a good way to go.
• You need to risk assess the patient before extraction.
• Palliative endo is technically always an option.
• Success in endo can be often difficult to achieve.
• Asymptomatic and functional is a good criteria.
• If endo is on the table, it’s feasible.

Highlights of this episode:

• 00:00 Teaser
• 00:35 Introduction
• 01:48 Protrusive Dental Pearl
• 04:15 Interview with Dr. Omar Ikram: Philosophy and Growth
• 10:17 Endodontics vs. Implants: Treatment Planning
• 16:35 Antidepressants and Dental Implant Failure
• 19:37 Managing External Cervical Resorption (ECR)
• 22:30 Patient Communication
• 24:16 Cracks and Complications in Endodontics
• 29:12 Endodontic Protocol
• 30:50 Challenges with CBCT and Cracks
• 32:07 Second Molars: Retain or Extract?
• 35:05 Retaining Roots for Future Implants
• 36:21 Root Burial and Special Cases
• 40:08 Root Amputation: A Niche Solution
• 40:57 Key Signs to Rethink Root Canal Treatment
• 43:17 Cracked Teeth: Poor Prognosis
• 47:08 Stained Crack Tooth
• 50:19 Success vs. Survival in Endodontics
• 56:02 Final Thoughts and Upcoming Events

Want to sharpen your endo game even further? Watch Stop Being Slow at Root Canals! Efficient RCTs with Dr Omar Ikram – PDP163

Check out Specialist Endo Crows Nest — led by Dr. Omar Ikram, offering expert care, hands-on courses, and practical tips for real-world endodontics.

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and C.

AGD Subject Code: 070 ENDODONTICS (Endodontic diagnosis)

Aim: To help clinicians develop a deeper understanding of when to preserve a tooth through endodontic treatment versus when to consider extraction and implant placement.

Dentists will be able to –

1. Identify key red flags that may contraindicate definitive root canal treatment.
2. Understand the concept of palliative endodontics and how it can be used to delay or defer implant placement responsibly.
3. Recognize the value of retained roots in maintaining alveolar bone, particularly in medically compromised or high-risk patients.

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