Over 25 years ago, dentistry focused on an overly simplistic idea:
If a tooth is compromised… remove it and place an implant.
This sounds clean. This sounds modern.
But it’s not always the answer.
Now we’ve come full circle.
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The truth? Nothing beats a natural tooth.
A natural tooth isn’t just a structure sitting in bone.
It’s connected by the periodontal ligament — a living, adaptive system that:
• Maintains bone
• Absorbs forces
• Allows movement and feedback
Take the tooth out… and that tooth- ligament and bone connection – formed whilst we were embryos is gone forever!
An implant?
It’s just a q screw in bone.
No ligament. No adaptation. No biological intelligence.
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Bone loss is not a complication of implants— it’s expected most of the time
Here’s the part patients are rarely told:
With implants, bone loss is built into the definition of success (Albrekstson).
• Up to 2 mm lost in year one
• Then 0.2 mm every year after
After 10 years?
Nearly 4 mm of bone gone… and it’s still called a “success.”
Now compare that to root canal treatment:
Success =
-No pain
-Complete healing of apical disease
-Disease eliminated
If it doesn’t heal after 5 years, most studies on outcome consider it not healed
The bar is completely different.
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And then there’s medications…
Modern patients aren’t the same as they were 20 years ago.
More people are taking:
• Bisphosphonates
• Denosumab
• Steroids
• Cancer therapies
• many antidepressants (SSRIs)
These can:
• Impair healing
• Reduce bone quality
• Increase implant failure risk
And here’s the key point:
Patients usually start these medications later in life — after the implant is placed.
So the risk goes up over time, not down.
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Implants are good! But Natural teeth are better.
Yes — implants have a role.
Yes — they can work very well.
But they are replacement parts, not equivalents.
A root canal–treated tooth:
• Preserves bone via the ligament
• is connected to the body and allows for growth changes over time
• Maintains natural function
• Avoids surgery
And long-term?
They perform extremely well.
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The real philosophy shift
The question shouldn’t be:
“Can we replace this tooth?”
It should be:
“Can we save it?”
Because once it’s gone…
you can never truly get it back.
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Bottom line
If a tooth can be saved — save it.
Root canal treatment should be the first choice, not the last resort.
Implants are for when a tooth is truly non-restorable.
That’s not old-school dentistry.
That’s biologically sound, long-term thinking
