HOME - Clinical cases - Endodontics
 
 
24 November 2020

ENDODONTIC RETREATMENT OF TEETH WITH UNCERTAIN ENDODONTIC PROGNOSIS VERSUS DENTAL IMPLANTS: 5-YEAR RESULTS FROM A RANDOMISED CONTROLLED TRIAL

M. Esposito, L. Sbricoli, J. Buti, U. Uccioli, M. Tallarico


PURPOSE. To ascertain whether it is better to endodontically retreat a previously endodontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis, or to replace the tooth with a single implant-supported crown.

MATERIALS AND METHODS. Twenty patients requiring treatment of a previously endodontically treated tooth with periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigator, were randomly allocated to endodontic retreatment (endo group; 10 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 10 patients) according to a parallel-group design at a single centre. Patients were followed up to 5 years after treatment completion. Outcome measures were: procedure failure; complications; marginal bone level changes at both teeth and implants; radiographic endodontic success (teeth only); number of patient visits and days to complete treatment; chairside time; costs; and aesthetics, as assessed using the pink aesthetic score (PES) for the soft tissues and the white aesthetic score (WES) for the tooth/crown by independent assessors.

RESULTS. One patient from the endo group dropped out. One endodontically retreated tooth fractured. There were no statistically significant differences in treatment failure between groups (difference in proportions = 0.1; 95% CI -0.18 to 0.35; P = 1.00). Three endo group patients had one complication each versus one complication in the implant group, the difference not being statistically significant (difference in proportions = 0.2; 95% CI -0.17 to 0.51; P = 0.582). The mean marginal bone levels at endo retreatment/implant insertion were 2.10 ± 0.66 mm for the endo and 0.05 ± 0.15 mm for the implant group. Five years after treatment completion, teeth lost on average 0.60 ± 0.96 mm and implants 0.56 ± 0.77 mm, the difference not being statistically significant (mean difference = -0.05 mm; 95% CI: -0.95 to 0.86; P = 0.914). Of the four teeth that originally showed periapical radiolucency, one was lost, two displayed complete healing, and one showed radiographic improvement. There were no statistically significant differences in the number of patient visits (endo = 6.7 ± 0.7; implant = 6.1 ± 0.7; mean difference = 0.6; 95% CI: -0.1 to 1.3 P = 0.106).

However, it took significantly more days (endo = 61 ± 13.0; implant = 191.4 ± 75.0; mean difference = -130.4; 95% CI: -184.5 to -76.4; P < 0.001) but less chairside time (endo = 628 ± 41.4 min; implant = 328.5 ± 196.4 min; mean difference = -299.5; 95% CI: -441.3 to 1.0; P = <0.001) to complete the rehabilitation. Implant treatment was significantly more expensive (endo = 1440 ± 549.7; implant = 2099 ± 170.3; mean difference = 659; 95% CI: 257.2 to 1060.8; P = 0.004).

Five years after treatment completion, mean PES were 12.3 ± (1.3) and 8.9 ± 2.2 and mean WES were 8.1 ± 1.4 and 7.1 ± 1.7 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference -3.4; 95% CI -5.1 to -1.6; P (t-test) = 0.001), whereas no significant differences were observed between treatments in tooth aesthetics (WES) (mean difference = -1.0; 95% CI -2.6 to 0.5; P (t-test) = 0.178).

CONCLUSIONS. These results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persistant pathology and dubious endodontic prognosis yielded similar medium-term success rates. Soft tissue aesthetics and treatment completion time were better with endodontic retreatment, whereas implant rehabilitation required half the chairside time but was significantly more expensive. Much larger patient populations and longer follow-ups are needed to fully explore this issue, but this study indicated the less invasive endodontic retreatment as the primary therapeutic option.


For additional information:  http://www.clinicaltrialsindentistry.com/endodontic-retreatment-of-teeth-with-uncertain-endodontic-prognosis-versus-dental-implants-5-year-results-from-a-randomised-controlled-trial/

Related articles

Authors: Marco Esposito, Luca Sbricoli, Jacopo Buti, Umberto Uccioli, Marco Tallarico

The purpose of the paper is to ascertain whether it is better to endodontically retreat a previously endodontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis,...


Pio Bertani, Massimo Gagliani, Fabio Gorni

Periapical pathologies of endodontic origin are often found in individual patients; in fact, they involve a large portion of the population. Acute diseases, or abscesses, are very common. These two...


Several milestone papers have been written in the last years on Endodontic Retreatments and some of the most important among them have been authored by Prof....


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...


The success of endodontic treatment derives from the complete elimination of microorganisms in intraradicular compartment. To achieve a more effective ...


Read more

Philips Avent, a mother, and childcare product corporation, has launched a new line of products, including an orthodontic-friendly pacifier. The new line is designed to aid in feeding babies and to...


Author: Giacomo Tarquini

Periodontitis is an inflammatory disease caused by the formation of a bacterial biofilm that, especially in predisposed subjects, may lead to periodontal ligament destruction and alveolar bone...


Independent dental implant and oral healthcare company, Keystone Dental Inc., completed a financing round that netted $25 million, led by investors, Nantahala, and joined by Accelmed and Migdal...


Dental caries and tooth wear remain an oral public health issue affecting nearly 100% of the adult population.  When the amount of lost tooth structure is important, often either a complete...


According to a recent report, Valuates Reports, a market analysis firm, has forecast the dental consumables market to grow at a CAGR of 3.9% between 2021 and 2027. The market is expected to reach...


 
 
 
 
 
 

Most popular

 
 

Events

 
 

Copyright © 2021 - All Rights Reserved
ISSN 2767-1178

Top