Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions

Abstract

This review describes practical criteria and a systematic process to aid the treatment planning decision of whether to preserve teeth by root canal treatment (RCT) or extract and provide an implant. Recommendations presented are based on best available evidence from the literature and the expert views of specialists in endodontics and restorative dentistry, including dental implantology. A MEDLINE search was conducted using the terms 'root canal therapy', 'dental implants', 'decision making', 'treatment planning', 'outcome' and 'human', and supplemented by hand-searching. When evaluating the outcome of root canal treatment, an observation period of 4-5 years is required for complete healing of periapical lesions. Dental implants, however, present a de novo situation and a functional period of at least 5 years is often required before peri-implant diseases are established and detected. Good long-term success rates and greater flexibility in clinical management indicate that RCT or retreatment should be performed first in most instances unless the tooth is judged to be unrestorable. When deciding if a compromised tooth of questionable prognosis should be maintained or replaced by an implant, both local, site-specific and more general patient-related factors should be considered. Following systematic evaluation and consideration of the best treatment option in a particular case, a treatment recommendation may then be given in favour or against tooth retention. Whilst single risks are possibly accepted for single tooth restorations, teeth with questionable prognosis and multiple pre-treatment requirements are better not included as abutments in fixed dental prostheses to reduce the risk to survival of the entire restoration.

The perceived prognosis of endodontic treatment and implant therapy among dental practitioners

“…16 A functional period of 5 years is often needed before peri-implantitis is established and detected. 13 It has been shown that without systemic support, peri-implantitis is common. 35 Although Ruskin believes implants are superior to endodontically treated teeth due to their ability to resist dental caries, periodontal disease and structural deficiencies, implants with peri-implantitis do not seem to be very successful at resisting complications.…”

“…These can consist of implant fractures, abutment or screw loosening or fracture, loss of retention of cemented restorations or fracture of the framework. 13 Also patients who experienced an implant failure had a 30% increased risk of further failure. 41 In looking at retreatments, endodontists were more inclined to retreat a tooth and take action when a peri-apical radiolucency was noted regardless of size compared to general dentists.…”

“…46 Along with these factors the strategic value of the tooth within the dentition and the extent of previous restorations should also be taken into account. 13 The condition of the adjacent teeth and the entire dentition must be taken into consideration in treatment planning. 13 While some believe that full deliberation should first be given to "traditional" dental interventions, such as preserving and restoring the natural dentition before extraction and implant placement, 12 others believe that given implants high predictability their use should be considered routine and that implant treatments are superior to heroic measures taken to save a natural tooth.…”

“…12 The less stringent criteria in implant studies translates to higher success rates for implants. 13 In reviewing the literature the quality of root canal treatment studies were found to be superior to implant studies. 14 Direct comparisons of success rates are futile.…”

“…This is even more apparent when early implant losses are not included in the failure rates. 13 Hannahan's study evaluated 143 endodontically treated teeth for an average of 22 months. He found a success rate of 99.3%.…”