Patients with diseased dental pulp have traditionally received nonsurgical root canal treatment. However, the development of modern osseointegrated dental implants has changed the calculus for many of these patients, and current trends appear to favor implants as the standard procedure in cases that would have previously undergone endodontic treatment. Although many studies have been conducted comparing outcomes from the 2 treatment options, establishing which procedure is more predictable remains problematic due to significant differences in study design and definitions, especially the differing measures of outcomes between treatment options.
Outcome criteria used in studies of nonsurgical root canal treatment include function, clinical signs and symptoms, and radiographic evaluation of periapical lesion healing; thus, even asymptomatic and fully functional treated teeth may be classified as failures if radiographs detect anything other than complete healing. Studies of implants, on the other hand, usually evaluate success based solely on implant survival. Vahdati, a private practitioner from California, et al compared outcomes in nonsurgical endodontically treated teeth and surgically placed implants using the same outcome measures in patients who had undergone both treatments in different teeth.
The authors analyzed the records of 3631 patients treated from 2001 through 2016 at the Loma Linda University School of Dentistry. The database included 170 patients aged ≥18 years (85 men, 85 women; mean age at last follow-up visit, 72 years) who met the following inclusion criteria:
- n ≥1 single-tooth implant surgery and subsequent restoration
- n ≥1 nonsurgical root canal treatment and subsequent restoration
- n both restorations had to be performed in the matching area of the mouth (anterior maxilla, posterior maxilla, anterior mandible, posterior mandible)
- n at least a 5-year follow-up
The authors recorded the patients’ demographic data and medical status, along with all subsequent treatment. Surviving implants were defined as being functional and present in the mouth at the time of final recall without definite signs of absolute failure. Surviving endodontically treated teeth were defined as being functional and asymptomatic at the time of final recall.
Both procedures had a 95% survival rate at 5 years. The large majority of the failures in both the implants and the endodontically treated teeth were located in the molar area. Demographics, tooth location, pretreatment diagnoses, pretreatment presence of periapical radiolucency, proximal contact, immediate vs delayed implant placement, implant size, and type of restoration after root canal or implant
placement had no statistical significance and no effect on survival rate. However, there were significant differences between treatment options in necessity for additional treatments, and cost and time to final restoration, all of which favored endodontic treatment (Table 1).
Given the equivalent survival rate of the 2 treatments and the significant differences to the patient in time, convenience and money, nonsurgical root canal treatment should be considered as a viable alternative for any tooth that can be saved and is deemed restorable.
Vahdati SA, Torabinejad M, Handysides R, Lozada J. A retrospective comparison of outcome in patients who received both nonsurgical root canal treatment and single–tooth implants. J Endod 2019;45:99-103.