If we fail to offer our patients the very latest technological innovations in diagnosis and care are we doing them a dis-service and providing second-tier dentistry?

The best imaging equipment, such as CBCT scanners, give a specialist enormous amounts of information. If a patient visited a dentist with access to a scanner, wouldn’t it be better if they were able to take a scan and say, for example, “The reason this restoration is failing is because you have a missed canal. Therefore the treatment I propose is X”?

That would be the gold standard of service, and in an ideal world offered to every patient. Unfortunately that level of diagnosis requires exposure to high degrees of radiation, prompting the argument of how a dentist could ethically irradiate each patient to such a level in order to achieve some diagnostic information? But if they didn’t, are they then failing to provide the greatest possible diagnoses?

Risks and Benefits

As with everything there are risks and benefits to be considered. The European Society of Endodontology recently released a statement of its position on the matter. It said, “A CBCT scan should have a net bene?t to the management of a patient’s (suspected) endodontic problem”.[1]

If it was up to a specialist and radiation wasn’t an issue, every patient would be scanned. Indeed in times to come this may be the case, but for now there must be this ‘net benefit’ that outweighs the radiation risks. Therefore the decision not to undertake a CBCT scan could be equally as ethically significant as the decision to do so.


So what about when the cost of the latest technology is only financial rather than physical?

25 years ago endodontists didn’t all use microscopes, and the old boys would say to us, “You don’t need microscopes; our fingers are our eyes”. Of course this wasn’t good enough, and therefore the specialism became two-tiered: those with microscopes and those without. This didn’t mean that the practitioners working without microscopes shouldn’t have been offering treatments - rather that for particularly complicated cases, they couldn’t hope to match the successes of those who did.

These are of course still early days for the technology, but there may come a time when if you don’t have access advanced imaging technology, yours will be a second-tier diagnostic service.

Naturally this is all a part of the process of progress; a reciprocating cycle that will continue and continue. New innovation will lead to better quality treatments, leaving those who don’t prescribe to the latest technological advances playing in the lower leagues. Thus there will always be those ethical questions around the level of service we can provide, and the truth of the matter is that it’s all in the balance of risks, benefits and cost.


For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk


Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.