Should we be doing more to save questionable teeth?



What if you could buy more time — without compromising patient care?



Dr. Omar Ikram returns for a powerful episode diving into the real-world decision-making between endodontics and implants. Together with Jaz, they explore tough scenarios — like teeth with nasty cracks or minimal remaining structure — and ask the critical question: when is it truly time to extract?



They break down concepts like retained roots, root burial, amputation, and a new term Jaz introduces — palliative endodontics. Because sometimes the best outcome isn't immediate replacement, but smart, strategic delay.




https://youtu.be/5msP908JvuI
Watch PDP238 on Youtube



Protrusive Dental Pearl: When discussing treatment longevity with older patients, tailor your language to be more relatable. Instead of saying, “I plan my dentistry to age 100,” say, “I want this to last well into your eighties or nineties.” This makes the conversation more personal and realistic, helping patients better connect with the concept of long-term outcomes.



Need to Read it? Check out the Full Episode Transcript below!



Key Takeaways




Understanding the limitations of implants compared to natural teeth is vital.



Medical history significantly impacts dental treatment decisions.



Managing patient expectations is crucial for satisfaction.



Palliative endodontics can provide temporary relief and management.



Reading and interpreting CBCT scans requires skill and experience. If it's not that five millimeter defect, it's up to you.



The second molar is a good one because often second molars can't be replaced with an implant.



Retaining roots is definitely a good way to go.



You need to risk assess the patient before extraction.



Palliative endo is technically always an option.



Success in endo can be often difficult to achieve.



Asymptomatic and functional is a good criteria.



If endo is on the table, it's feasible.




Highlights of this episode:




00:00 Teaser



00:35 Introduction



01:48 Protrusive Dental Pearl



04:15 Interview with Dr. Omar Ikram: Philosophy and Growth



10:17 Endodontics vs. Implants: Treatment Planning



16:35 Antidepressants and Dental Implant Failure



19:37 Managing External Cervical Resorption (ECR)



22:30 Patient Communication



24:16 Cracks and Complications in Endodontics



29:12 Endodontic Protocol



30:50 Challenges with CBCT and Cracks



32:07 Second Molars: Retain or Extract?



35:05 Retaining Roots for Future Implants



36:21 Root Burial and Special Cases



40:08 Root Amputation: A Niche Solution



40:57 Key Signs to Rethink Root Canal Treatment



43:17 Cracked Teeth: Poor Prognosis



47:08 Stained Crack Tooth



50:19 Success vs. Survival in Endodontics



56:02 Final Thoughts and Upcoming Events




Want to sharpen your endo game even further? Watch Stop Being Slow at Root Canals! Efficient RCTs with Dr Omar Ikram – PDP163



Check out Specialist Endo Crows Nest — led by Dr. Omar Ikram, offering expert care, hands-on courses, and practical tips for real-world endodontics.



This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 



This episode meets GDC Outcomes A and C.



AGD Subject Code: 070 ENDODONTICS (Endodontic diagnosis)



Aim: To help clinicians develop a deeper understanding of when to preserve a tooth through endodontic treatment versus when to consider extraction and implant placement.



Dentists will be able to -




Identify key red flags that may contraindicate definitive root canal treatment.



Understand the concept of palliative endodontics and how it can be used to delay or defer implant placement responsibly.



Recognize the value of retained roots in maintaining alveolar bone, particularly in medically compromised or high-risk patients.




#PDPMainEpisodes #EndoRestorative #BreadandButterDentistry







Click below for full episode transcript:



Teaser: Biggest difference between implants and retaining the tooth through root canal treatment is that implants, that's the big difference. Sometimes when you say to patients, you'll be dealing with an implant failure in your lifetime.



Teaser:They look at you like, really? I thought implant would last till I was a hundred. How long anyone's gonna last on this planet? But in my planning, I plan to age 100. So I see everyone as living to age 100. And so my planning, I don't think this will make it, therefore--



Your health is within your own control. Also, it might be only 50%, 25%, but some of it's within your own control. I want the patient to go on holiday and not be sitting there worrying about whether their tooth might be bothering and they have to go to a dentist and take antibiotics--



Jaz's Introduction:Endodontics versus Implants: is this even a worthy battle? Let's be honest, right. Any implant dentist worth their salt would agree that for themselves or their family member where an Endo is feasible and you have a good prognosis, that that is the obvious choice first before having an implant, because an implant will still be an option for the future. And that's pretty much easy and unanimous in dentistry. Unless of course your patient suffers from titanium deficiency disease.



Now where this becomes more pertinent is those dubious scenarios, lack of tooth structure, those nasty cracks we've particularly discussed these two scenarios. Whereby perhaps we should be considering implants. But wait, Dr. Omar Ikram may have a few things to say about that and why we should be considering perhaps root filling, retained roots, root burials, amputation, and a term I introduced called Palliative Endodontics. Why that might have a growing role so that we can defer implants because we know implants do not last forever, Endo doesn't last forever, nothing lasts forever. So important about seeing the bigger picture when it comes to longevity.



Dental PearlHello, Protruserati I'm Jaz Gulati. Welcome back to your favorite Dental podcast. Every PDP episode, I'll give you a Protrusive Dental Pearl. Now, there is a theme in this podcast where we discuss about the age of the patient. We all know it's better to have an implant when you are 60 or 70, than when you're 40. And one thing I always did is when I communicate to patients, I was inspired by a consultant in Restorative Dentistry Dr Chander used a line to a patient. 



He said, "Look, I don't know how long anyone's going to live for, but I always plan my dentistry to age 100." And I've been using this line to my patients, and yeah, it's okay it works well, they get to see the bigger picture. But a lot of patients can't relate to that. A lot of my patients, their 60's, 70's, and 80's they just can't relate to that.



They immediately start thinking off topic and thinking, oh, I probably won't make it. So one of the changes I've made in communication based on what Omar discussed with me today, and really the pearl I want to pass on to you is instead of saying to age 100 for everyone, look at your patient. Let's say they're in their 70's and then you wanted to say, "Look, I want this to last well into your 80's maybe into your 90's. 



Now, they may still think, "Oh, I probably won't make it." But it's just a bit more relatable than putting a number age 100, because chances are most people don't know a 100-year-old, but they might have friends in their 80's and 90's. Do you see what I mean? Obviously, it's a very niche scenario. But me personally, I have a very age population that I look after my patients on average are 60.



And so this change in terminology in the way I communicate to patients in terms of longevity of treatment. I think's gonna really help me to get the point across well into your 70's well into your 80's. And you'll hear this again in this episode being a big part of today in this episode with specialist ended on Dr. Omar Ikram. 



Before we join the main episode, have you downloaded the app yet? The best way to do it, if you haven't already, is visit the website www.protrusive.app. Once you're there, make your account. Then once you've made your account, you could download the iOS or Android app and log in to find the nicest and geekiest community of dentists in the world.



What I've found is that dentists join the app for the content. The premium notes, the transcripts, the Protrusive Vault, our Mini Master Classes and Courses, just a better overall listening and watching experience. But what they stay for is the community. What they find is that they fall in love with dentistry all over again because dentistry can feel so lonely and isolated. 



And on some of these social media groups, you get shot down when you ask for opinions. But really, we've brewed a culture very hard to brew, a culture of kindness, being considerate and selflessly sharing information. So remember, the website is protrusive.app. The app is called Protrusive Guidance, I would love to see you on there. Let's join the main episode with Dr. Omar Aram and at the end, of course, you can answer the quiz to get your CE credits on the app.



Main Episode:Omar, welcome back to the show. I just saw you post on Instagram, so you are on the bike doing a marathon. Tell me more about that.



[Omar]Oh no, it was just one of those big days at work and I was doing an extra bit of punishment for exercise. I tend to do this to myself when things get tough, I think what's something I can do for 20 more minutes? You've had that big day, you think I can't do it anymore. And it's like, you can, and by doing that, what you're doing is you're just pushing yourself that extra bit and saying, "You know what? Even those hard days in clinic, I can still do a bit more. "



[Jaz]I love that. It reminds me of a book. The David Goggins book? Can't Hurt me. 



[Omar]Yes, yes, yes. Have 



[Jaz]You read that one? 



[Omar]Yep. That's a favorite of mine. That's a good one. 



[Jaz]I mean,