Endodontic Versus Implant Success Rates

[drmithila]

A review of the literature and a summary of factors that are predictive of success and failure of implants and en­dodontically-treated teeth were published in a study in Dental Clinics of North America. Another objective of the study was to provide the clinician with a “decision tree,” or algorithm, to assist in the decision to either (1) re­move a compromised tooth and re­place it with an implant-supported restoration or (2) provide endodontic therapy to preserve radicular tooth structure in order to retain and support a definitive restoration. The study evaluated currently reported success rates for implants and endodontically treated teeth and assessment of the costs of the 2 procedures. In addition, the effects of smoking, periodontal condition, posts, systemic diseases, and new imaging technologies on the respective outcomes were evaluated. Currently re­ported survival rates are high for both implants and endodontically treated teeth (approximately 90% after 10 years), although both interventions can be improved. Re­cently developed advantages of im­plants include the ability to co-deliver pharmacologic agents, faster integration, and decreased crestal bone loss. Current endodontic treatment provides better apical and coronal seals, improvements in disinfection of root canal systems, and microscopic visualization for diagnosis and during canal preparation. The study concluded that the inability to incorporate a ferrule for the final coronal restoration, failure to expeditiously restore, and lack of at least 2 walls of coronal tooth structure are major reasons for failures of endodontically treated teeth. Endo­dontic priority should be given to periodontally sound teeth, while implants should be used in cases of nonrestorability. Diabetes, but not smoking, appears to compromise outcomes with implants. Before undertaking en­dodontic treatment over tooth re­moval and implant placement, the clinician should consider the need for sufficient coronal tooth structure and the presence or absence of a compromising periodontal condition.

        

[drsnehamaheshwari]

 

 

Dr. Nowzari discussed the difference between the tooth and an implant from a unique perspective. Often left out of the discussion regarding implants is the importance of the periodontium and how loss of the the periodontium (tooth, periodontal ligament, dental papilla, supracrestal fibers, lamina dura) affects the remaining gingival esthetics, including the esthetics around the dental implant.

 

It is well known that anterior gingival esthetics around an implant are one of the most challenging parts of implant dentistry.  The reason this is so challenging, is that the natural periodontal tissues (see image) that give the gingiva it’s phenotype (appearance) are gone.  An implant’s best chance at "natural-looking" gingiva/papilla is a natural tooth next door!  Dental papilla belong to teeth.  

 

While implants have an important part in dentistry, an implant can never effectively reform the periodontium.  The bundle bone and the family of fibers (dentogingival, dentoperiosteal, alveologingival, periosteogingival, interpapillary, intergingival, circular, semicircular, transgingival, intercircular, transeptal fibers) that create the architecture of the dental papilla all belong to the tooth.

 

This debate between implants and endodontics should not exist.  Implants and root canals are not alternative treatments.  If a tooth and its surrounding periodontium is in tact, we should make every effort to preserve them, because an implant cannot restore these periodontal tissues and loss of these tissues leads to a host of other challenges.

 

Dr. Nowzari hosts a periodontal & implant symposium that may be one of the few (if only) implant CE events that is not sponsored or underwritten with any commercial interest (also available for download).  It may also be the only of its type where endodontists and implant surgeons participate together. 

 

 

        

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