ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Long-Term Success Rate May be Greater for Patients with Extraction and Implant Compared to Apical Surgery
Clinical Question In patients requiring surgical retreatment after failed orthograde endodontic treatment, does apical surgery, compared to extraction and implant, afford a greater long-term success rate?
Clinical Bottom Line Patients with failed orthograde endodontic treatment may have a higher success rate of long-term survival with extraction and implant versus apical surgery of the tooth, especially when treatment is provided by specialists.
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) 24065635Setzer/201414 papers includedLiterature Review
Key resultsTwo meta analyses (Setzer et al., 2010) focusing on apical microsurgery presented 91.4-93.5% success rates after 1 year. In another meta analysis (Lindh et al., 1998) focusing on implants presented a 6-7 year follow up with 96.7-97.5% success rate. A large scale study (Boioli et al., 2001) for implants presented a 92% success rate after 15 years with a two-stage process, while a one-stage process presented with an 85% success rate after 10 years. A 20-year follow up (Chappuis et al., 2013) of implants presented with a 75.8% success rate and 89.5% survival.
Evidence Search PubMED Search; “Apicoectomy” MeSH, “Apical surgery” MeSH “implant versus endodontic treatment” Mesh, “Endodontic Microsurgery” MeSH
Comments on
The Evidence
The current evidence does not conclusively show that the long-term prognosis is in favor of implants versus apical microsurgery. Currently, there are no articles in the literature with a side-by-side comparison of apical microsurgery and implants. It is difficult to compare endodontic success (resolution of periapical pathology) with survival of implants. Implant survival simply means the implant is still in place, regardless of potential pathology, ability to load, esthetic problems, etc. Before an accurate comparison may be made, a clearer definition of implant success needs to be established.
Applicability Applicable to providers managing patients with failed endodontic treatment. Implants placed by specialists had a 95.5% success rate versus 73% by inexperienced dentists. Endodontic therapy performed by endodontists had a 98.1% success rate versus 89.7% when completed by general dentists. The long term health and benefit to the patient should be the first consideration when deciding between endodontic microsurgery or placing an implant.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery)
Keywords Apical surgery, long-term study, outcome, predictors, prognostic factors, dental implants, endodontic therapy, oral health, systematic review, treatment planning, clinical outcome, endodontic microsurgery, long-term follow-up, success rate
ID# 2753
Date of submission: 08/01/2014spacer
E-mail shayan.salim@ucdenver.edu
Author Shayan Salim
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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