InquiryTo treat or extract and implant
Section snippets
Background
A hot debate rages concerning when teeth should be extracted and implants placed and when they should be retained and restored. Endodontically treated teeth tend to be seen as inferior to implants with respect to long-term stability and retention, but the process of extracting a tooth or teeth and placing an implant or several implants is not always simple or ethically defensible. The issues of retention versus replacement, misconceptions about endodontic therapy and implants, and current
Implants
Modern dental implantology began with the development of screw-type, root-form implants that heal by osseointegration, with vital bone and titanium surfaces directly apposed. Patients who are completely or partially edentulous can enjoy great benefits with the placement of implants. Implant studies often cite outcome rates of more than 95%. The complications most often seen with implants are peri-implantitis, which is more common in multiple-implant situations; difficulty restoring the site
Endodontic Therapy
For single teeth requiring treatment, the options include implants but also restoration, extraction without replacement, and replacement by fixed partial dentures (FPDs) on natural teeth. FPDs tend to be poorly regarded because of the need for extensive preparation and loss of healthy tooth structure. The criteria used to evaluate endodontic outcome success are stricter than those used for implant survival. Healing may take up to 4 years or longer, but primary endodontic treatment has yielded
Comparisons
It is difficult to compare the outcomes with endodontic therapy, which are subject to strictly defined success criteria, with those of implant outcome data, which are based on survival, not success. The reported outcome rates for implants may be highly inflated because most studies are funded by the industry, risking bias; strict inclusion/exclusion criteria for patient selection in these trials are observed that exclude many patients seen in an average clinical setting, such as those who
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Setzer FC, Kim S: Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res 93:19-26, 2014
Reprints available from S Kim; e-mail: [email protected]