JIACD
The Journal of Implant & Advanced Clinical Dentistry
Root Amps- Are they still a valid treatment?
Mon, 05/18/2009 - 16:16 — hawkeye
I have a couple of patient in my office that had root amps from my local periodontist. I restored them and they been doing well ever since. Implants have overtaken what appears to me as a good treatment to save a tooth. Any periodontist out there doing root amps? Do you find them to be successful?
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Root Amp is still viable treatment
I just did one with my local periodontist where the patient couldnt afford the implant and we opted to do the root amp and restore. 1 year out she is doing great with no issues.
Root amputations
I agree with the previous post regarding the importance of restorative and occlusion. Root amputations of upper molars must be separated from lower molar hemi-sections. With the advent of implants the lower hemi-section should be a lost art. To me, the only root amputation that has a long term chance at success given the proper restorative and monitoring of the occlusion correctly is primarily the DF on the upper first molars and secondarily DF on upper second molars. MF root amputations are not a good choice mainly for esthetic reasons. The upper first molar is the tooth of choice. Don't forget the importance of (1)the proper surgical technique and (2) the proper odontoplasty technique. And, the osseous destruction of the DF furcation cannot be too advanced. So, there are several factors involved in the determination of success. The size and shape of the roots are also important. The restorative techniques of Melker and Strupp are viable options when treating furcations either with or without root amputations.
I respectfully disagree, Root amps not without merit
Sinuslifter while I appreciate your comments and they are certainly not off base. Root amps can still be a variable option.
1) On expense: Not sure where you practice but in my area, a molar root canal on average is 1200, a pfm or gold crown is 800-1200 and I charge 900 for a root amp. So in total that about 3300 roughly vice about 4500 to 5000 for the implant and that doesnt include the extraction and most likely the sinus lift that will be needed.
2) You dont necessarily need to splint. I have 10 cases in my office restored by a prosthodontist that didnt splint. You need to manage the occlusion correctly.
You can clearly see the difference in success based on restorative outcomes in some papers. The Langer study had a low success but if you look closely, Langer practices in Manhattan where his root amps where restored by many different restorative docs with differing experience levels. On the other hand the Carnivale studies show high success, but in those studies they where restored by pros who had knowledge on how to properly restore and manage the occlusion.
3) Some people want to hold on to their teeth as long as they can, not everyone wants an implant. As a periodontist, I still try and save teeth, and a root amp can still be a cost effective treatment if managed correctly.
Root amps outdated
Root amps are like gold foils. Sure they work, but they are so outdated...
Personally, I would never do a root amp. First of all, you are going to charge the patient for the root amp surgery. Then the patient will need to pay for a root canal. Next the patient will need to pay for a crown. If the root amped tooth is not splinted to another tooth, there is a high likelihood of frature...then you need to replace with an implant.
Why not save the patient some trouble and do the implant right away? The cost is about the same (or less even). They are charged for the surgery and the abutment/crown. There is no root canal charge and you do not need to splint the restoration to another tooth.
The favorable lit on the root amps leaves out a few KEY bits of information. First, the prosthodontists that restored those cases were some of the best in the world. Second, most of those restorations were splinted to other teeth. If you dig deep, you find that unsplinted restorations tend to fracture at about 5 years out.
Root Amps- Are definitely a valid treatment if......
Root amps are still a valid treatment provided you get them restored properly. Failure to properly manage the restoration and occlusion will ultimately leade to failure.
This is a great study that had strict parameters for failure and success.
Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years.J Periodontol. 2001 Aug;72(8):1113-23.
BACKGROUND: When faced with a furcated molar, today's clinician must decide between a number of treatment options, including root resection, tooth removal, and implant placement. This paper assesses the results in one private clinical practice of root resection and subsequent restoration or molar implant placement and subsequent restoration. Clinical considerations in treatment selection are discussed. METHODS: A retrospective analysis of treated patients was carried out by examining active and inactive patient charts. When patients had discontinued therapy, every effort was made to determine the reason for leaving the private practice, so as to assess the impact of previously undocumented treatment failure on the statistics in question. RESULTS: A total 701 root resected molars and 1,472 molar implants were evaluated after > or = 15 and 13 years in function, respectively. Resection of the distal root of a mandibular molar demonstrated the lowest success rate (75%). All other success rates for various root resected molars in function ranged from 95.2% to 100%. Lone standing implants in second molar positions demonstrated the lowest success rate (85%). All other implant use in molar positions demonstrated a success rate ranging from 97.0% to 98.6%. Root resected molars and molar implants demonstrated the highest degree of failure when they were lone standing terminal abutments. Seven out of 23 (30.4%) root resected molar failures, and 17 of 45 (37.8%) of the molar implant failures were associated with untreated parafunction. Cumulative success rates were 96.8% for root resected molars and 97.0% for molar implants. Success and failure are discussed by tooth and/or implant position, and resected root, where applicable. Possible ramifications of these findings upon treatment planning are also reviewed. CONCLUSIONS: Both molar root resection and appropriate restoration and molar implant placement and restoration demonstrated a high degree of success in function. However, this success rate is markedly affected when either the root resected molar or molar implant is a lone standing terminal abutment. Care must be taken to choose the appropriate treatment modality for a given patient scenario