ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Insufficient Evidence Supporting the Efficacy of Intentional Replantation as a Modality of Endodontic Retreatment Over Extraction and Implant Placement
Clinical Question In patients requiring endodontic retreatment, who are not candidates for apical surgery, is intentional replantation as efficacious as extraction and implant placement in terms of long-term success rate?
Clinical Bottom Line There is insufficient evidence to support the efficacy of intentional replantation as a method of endodontic retreatment. When apical surgery is not an option, extraction and implant placement is more reliable in terms of long-term success rate.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 14998415Peer/20079 Patients who underwent Intentional replantationCase series
Key resultsNine case reports were presented describing the use of intentional replantation as a treatment method. Only one of the nine cases showed evidence of failure with follow up times ranging from 6 months to 4 years (average time was 23 months). It was concluded that intentional replantation was a reliable and predictable method.
#2) 8247504Bender/199331 Patients that underwent Intentional replantationCase series
Key resultsThirty-one cases of intentional replantation were used to report an overall success rate of 80.6%, with survival ranging from 1 day to 22 years. It is suggested that intentional replantation should not be considered a treatment of last resort, and that it is the treatment of choice over apicoectomy when teeth have been treated or retreated unsuccessfully with conventional endodontic therapy and all clinical factors have been considered.
#3) 24396380Asgary/201420 Patients that underwent Intentional ReplantationCase series
Key resultsTwenty cases of intentional replantation were used to report a 90% success rate over 2 years. Case selection was an integral factor in success rates.
#4) 14998415Setzer/2013Patients requiring endodontic therapy/extractionLiterature Review
Key resultsBoth implants and endodontically treated teeth have significant outcome rates. The survival rate of implants was 73.0% when placed by inexperienced practitioners and 95.5% when placed by implant specialists.
Evidence Search “Tooth replantation” [MeSH], “Dental Implants” [MeSH]
Comments on
The Evidence
Currently, the indication to use intentional replantation as a method for endodontic retreatment, when apical surgery is not an option, is limited since there is no evidence-based data from controlled clinical trials. Recent case studies show that intentional replantation can be a reliable, predictable procedure. As there has not been a study that directly compares intentional replantation to implants, there is no statistical analysis available to compare the procedures. Randomized clinical trials directly comparing success rates of each procedure are needed to provide higher levels of evidence.
Applicability Applicable to providers managing patients requiring endodontic retreatment that are not candidates for apical surgery. It is important to note that the apparent success rates for intentional replantation is approximately 80-90% while implants placed by specialists show a 95% success rate. Without controlled clinical trials showing efficacy of intentional replantation, implants should be considered as the better treatment choice.
Specialty/Discipline (Endodontics) (General Dentistry) (Restorative Dentistry)
Keywords Endodontic Retreatment, Intentional Replantation
ID# 2750
Date of submission: 07/23/2014spacer
E-mail amana.farrkh@ucdenver.edu
Author Amana Farrkh
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ethelyn.thomasonlarsen@ucdenver.edu
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