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16 July 2019

Endodontics VS Implantology

Simona Chirico

Is it better to try to preserve a dental element with every possible means or to place an osseointegrated implant? There is a great variability of response from clinicians on how to deal with non vital tooth with a questionable prognosis.

Nowadays, dental implant placement is a widely accepted treatment option, and it is supported by high survival rates. However, there are many factors that can affect the result of implant treatment like implant position, restoration type, bone quality, and smoking habits. So our decision should be based on the remnant tooth structure and prognosis. It’s difficult to compare endodontics and implantology, because they have different outcomes. When we talk about endodontics, we dealt with “success” of a root canal treatment/retreatment/apical surgery and it is defined by complete radiographic healing and the absence of clinical signs and symptoms. Instead, the majority of studies on dental implants refer to “survival” rates. So Which is the best treatment option for a pulpally involved tooth?  Chércoles-Ruiz et al. tried to give an answer in their study.

An electronic search was conducted in the Cochrane, PubMed (MEDLINE), and ScienceDirect databases be- tween December 2015 and February 2016. A manual search was also performed. The inclusion criteria were randomized clinical trials, prospective or retrospective cohort studies, and cross-sectional studies performed on humans with at least 1 year of follow-up and pub- lished within the last 10 years. Two researchers indepen- dently screened the title and abstract of every article identified in the search in order to establish its eligibility. The selected articles were classified into different levels of evidence by means of the Strength of Recommendation Taxonomy criteria.

The success rate of endodontic treatment varies from 42.1%–86% after 2 to 10 years and from 84.1%–88.6% after 4 to 10 years for endodontic retreatment. The majority of studies do not specify assessment criteria.  
The apical surgery success rate ranges from 59.1%–93% after 1 to 10 years, and the most used assessment criteria is based on radiologic criteria. The survival rate of dental implants varies from 91.8%–100% after 1 to 10 years. None of the selected articles have assessed the success rates. No apparent differences on survival rates were noted depending on the time of placement.
No important differences between both treatments can be observed until after 8 years of follow-up.

The endodontic treatment and the implant placement are both valid and complementary options for planning oral rehabilitation. Although:
these results come from retrospective comparative studies because there is a lack of randomized clinical studies comparing both types of therapeutic options;
Studies on dental implants are less demanding than those studies on endodontics because the majority of them only provide information on survival and not success rates.
Therefore, if we really wanted to compare the two methods, we should produce studies in which the same outcomes are set and evaluated over time.

(Photocredit: Prof. Massimo Gagliani)

For additional informations:
Endodontics, Endodontic Retreatment, and Apical Surgery Versus Tooth Extraction and Implant Placement: A Systematic Review

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