Endodontists are specialists dedicated to preserving a patient’s existing natural teeth. Their expertise is concentrated on the inner structures of the tooth, a field known as endodontics. Placing an artificial tooth root, or dental implant, falls within the domain of other surgical specialists. This division of labor ensures patients receive highly focused and skilled care, whether the goal is to save a tooth or replace it with a prosthetic solution.
The Endodontist’s Specialty: Saving Natural Teeth
An endodontist is a dental specialist who completes four years of dental school followed by two or more years of advanced training. This training focuses exclusively on the dental pulp (the tissue containing the nerves and blood vessels inside the tooth) and the tissues surrounding the tooth root. Their practice is built around the diagnosis and treatment of diseases and injuries affecting the soft tissues within the tooth. The goal of this specialty is to retain the natural tooth whenever medically appropriate.
The most well-known procedure is Root Canal Treatment (RCT). This involves removing infected or inflamed pulp, cleaning and shaping the inner canals, and sealing the space to prevent further infection. Endodontists also perform complex procedures such as endodontic retreatments, which address previously treated teeth that become re-infected. They also conduct microsurgical procedures like an apicoectomy, which involves removing the infected tip of the tooth’s root when standard RCT is insufficient.
Endodontists manage dental trauma, treating fractured, dislodged, or knocked-out teeth to stabilize the tooth and promote healing. Their specialized training and use of advanced imaging technology, like Cone-Beam Computed Tomography (CBCT), allow for highly precise diagnosis and treatment. This focus on the internal architecture of the tooth increases the likelihood of successfully preserving a damaged tooth.
Who Places Dental Implants?
Dental implants are titanium posts surgically placed into the jawbone to serve as a stable anchor for a replacement tooth. This surgical procedure is typically performed by specialists with extensive training in oral surgery and bone grafting. These specialists focus on the hard and soft tissues surrounding the teeth, which differs from the endodontist’s focus on the tooth’s interior.
The primary specialists who perform implant surgery are Oral and Maxillofacial Surgeons (OMS) and Periodontists. Oral surgeons complete several years of hospital-based surgical residency, qualifying them for procedures involving the jawbone and facial structures. Periodontists specialize in the gums and supporting jawbone structures, and they are trained to perform all aspects of implant surgery. This includes necessary preparatory procedures like bone grafting or sinus lifts.
Some general dentists and Prosthodontists may also place implants after completing extensive post-graduate training and certification. Prosthodontists specialize in the restoration and replacement of missing teeth. They work closely with the surgical specialist to ensure the implant is placed optimally for the final artificial crown. Implant placement is a team effort, where the surgeon provides the foundation and the restorative dentist creates the visible tooth.
The Decision Point: Save, Replace, or Collaborate
The decision to save a tooth with endodontic treatment or replace it with an implant is a complex diagnostic process where dental professionals often collaborate. The endodontist provides the initial, highly specialized assessment regarding the tooth’s prognosis, which is its likelihood of long-term survival. They determine if the tooth structure is intact enough, if the root can be fully disinfected, and if the tooth can be properly restored after treatment.
If the endodontist determines the tooth cannot be saved due to issues like a severe fracture, extensive bone loss, or an untreatable infection, the treatment plan transitions from “save” to “replace”. At this point, the endodontist refers the patient to an implant specialist, such as an oral surgeon or periodontist, to discuss extraction and replacement options. This sequential approach ensures that every opportunity to preserve the natural tooth is explored by the most qualified specialist before moving to a surgical replacement.
This collaboration highlights that endodontists and implant specialists are not in competition but rather offer complementary services to achieve the best outcome for the patient. The endodontist’s role is to act as the gatekeeper, using their expertise to avoid unnecessary extractions, while the implant specialist provides a reliable solution when a tooth is deemed nonsalvageable. This interdisciplinary treatment planning ensures that patients receive comprehensive care that prioritizes both tooth preservation and functional tooth replacement.