At the recent AAE Convention, Dr. Hessam Nowzari presented a lecture on implant outcomes. Dr. Nowzari is a diplomate of the American Board of Periodontology and the former director of advanced periodontics at USC from 1995 to 2012.
Dr. Nowzari discussed the difference between the tooth and an implant from a unique perspective. Often left out of the discussion regarding implants is the importance of the periodontium and how loss of the the periodontium (tooth, periodontal ligament, dental papilla, supracrestal fibers, lamina dura) affects the remaining gingival esthetics, including the esthetics around the dental implant.
It is well known that anterior gingival esthetics around an implant are one of the most challenging parts of implant dentistry. The reason this is so challenging, is that the natural periodontal tissues (see image) that give the gingiva it's phenotype (appearance) are gone. An implant's best chance at "natural-looking" gingiva/papilla is a natural tooth next door! Dental papilla belong to teeth.
While implants have an important part in dentistry, an implant can never effectively reform the periodontium. The bundle bone and the family of fibers (dentogingival, dentoperiosteal, alveologingival, periosteogingival, interpapillary, intergingival, circular, semicircular, transgingival, intercircular, transeptal fibers) that create the architecture of the dental papilla all belong to the tooth.
This debate between implants and endodontics should not exist. Implants and root canals are not alternative treatments. If a tooth and its surrounding periodontium is in tact, we should make every effort to preserve them, because an implant cannot restore these periodontal tissues and loss of these tissues leads to a host of other challenges.
Dr. Nowzari hosts a periodontal & implant symposium that may be one of the few (if only) implant CE events that is not sponsored or underwritten with any commercial interest (also available for download). It may also be the only of its type where endodontists and implant surgeons are participate together. We would highly recommend you check it out.