ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Long Term Difference In Outcome Between Root Canal Therapies and Single-Tooth Implants
Clinical Question What are the benefits and the success rate of non-surgical root canal therapies vs. single-root implants?
Clinical Bottom Line No difference in the long-term outcome between the two treatments modalities. The decision to treat a tooth endodontically or to extract and replace it with an implant should be based on clinical criteria. (See Comments on the CAT below)
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) 19548936Zitzmann/2009Patients with either root canal treated or implant placedSystemic review
Key resultsAccording to a recent meta-analysis, the pooled outcome of primary RCT was 75% when strict success criteria (absence of periapical radiolucency) were applied, and reached 85% based on loose criteria (reduction in size of radiolucency). In teeth without a periapical radiolucency, initial RCT success rate after 8-10 years was 96%, whilst 86% in cases with pulp necrosis and periapical radiolucency (Sjogren). Reasons for failure of RCT teeth are prosthetic reasons (crown/ root/ traumatic fracture; 60%); 32% failed due to periodontal reasons, while endodontic failures were less than 10%. The 10-year survival rates reached 93% (implant-FDP) and 94% (single tooth implants) whilst survival of the implant restorations varies between 87% (implant-FDP) and 90% for the ISC. Implant reconstruction’s exposed to biological or technical complications were at greater risk of failure.
#2) 18436028Iqbal/2008Patients with either root canal treated or implant placedReview
Key resultsEndodontic complications, trauma, and caries are the leading causes of tooth extraction and replacement with single-tooth implants while 28% of implant placement was previously endodontically treated. Single-tooth implants (n=459) achieved a 4-year survival rate of 97% with 20% associated with postoperative complication. The outcome of initial endodontic treatment done in 1,462,936 teeth of 1,126,288 patients across the US and 97% of teeth were retained in the oral cavity 8 years after initial non-surgical root canal treatment. 85% had no full coronal coverage. Although the study did not perform subgroup analysis of survival of RCT with or without coronal coverage, the overall survival rate of RCT teeth 97.6%; therefore, the RCT teeth covered with crowns could be even higher. A total of 55 single-tooth implant (totaling 11,971 implants) and 13 endodontic (totaling 21,649 RCT teeth) studies were review in this article. The estimation of implant survival was 95% (95% confidence interval, 95-97%), whereas for RCT teeth was 94% (95% confidence interval, 91-97%).
#3) 17936128Torabinejad/2007Patients with either root canal treated or implant placedMeta-analysis Systemic review
Key resultsBenefits of RCT may include conservation of the natural tooth structure, preservation of alveolar bone and papillae, preservation of pressure perception, and lack of movement of the surrounding teeth. Conversely, it may increase the risk for future root fracture and development of the caries or periodontal disease. Implants have benefits of prevention of the bone resorption after extraction plus self-image and esthetics. The study reported a 5-year endodontic survival rate of 93% for 1.56 million teeth sample in a Taiwanese population. The superior long-term survival rates of endodontic therapy suggest that this should be given priority in treatment planning for periodontally sound teeth with pulpal and or periradicular pathology. The superior long-term survival rates of single tooth implants suggest that this should be given priority for teeth that are planned for extraction. Survival rate of RCT and single-tooth implants are nearly the same.
Evidence Search Search "Dental Implants, Single-Tooth"[Mesh] AND "Root Canal Therapy"[Mesh] Limits: Systematic ReviewsSearch "Dental Implants, Single-Tooth"[Mesh] AND "Root Canal Therapy"[Mesh] Limits: Randomized Controlled Trial, Search "Dental Implants, Single-Tooth"[Mesh] AND "Root Canal Therapy"[Mesh] Limits: Meta-Analysis, Search "Dental Implants, Single-Tooth"[Mesh] AND "Root Canal Therapy"[Mesh] ...view in PubMed
Comments on
The Evidence
These reviews have accumulated and integrated data from numerous different articles with the similar shared foundations. The fact that they are the most recent studies on this topic makes them a legitimate source of evidence.
Applicability Clinicians must look at the clinical presentations and consider patient desires and values to decide the best choice of the two treatment modalities.
Specialty/Discipline (Endodontics) (Oral Surgery) (Prosthodontics)
Keywords Single-tooth implants, root canal therapy
ID# 568
Date of submission: 03/31/2010spacer Revised: 10/03/2011
E-mail kims8@livemail.uthscsa.edu
Author Sung Kim
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Jennifer Kim
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Yen-Han Yang (San Antonio, TX) on 04/20/2012
I conducted a search on PubMed in April of 2012 and found a more recent publication with the PubMed ID of 20654764 addressing this question. However, this publication was a systematic review that finds the same results as published in this CAT and refers to the same studies as the evidence found here.
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