Endodontic retreatment vs dental implants of teeth with an uncertain endodontic prognosis: 1-year results from a randomised controlled trial. 

By Esposito M, Tallarico M, Trullenque-Eriksson A, Gianserra R. 

Date: 08/2017
Journal: Eur J Oral Implantol

Summary:

Purpose: To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown.

•Materials/Methods:

•Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis randomly allocated to endodontic retreatment

      (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown

      (implant group; 20 patients) according to a parallel group design at two different centres

•Patients were followed to 1 year after completion of the treatment.

• Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients’ visits and days to complete the treatment, patients’ chair time, and costs recorded by independent assessors.

Most highlighted Results: 

•No patient dropped out and no complications occurred during the entire follow-up.

•one endodontically retreated tooth (5%) and one implant (5%) fractured. •he difference for treatment failures being not statistically significant (difference in proportions = 0; 95%.

•The mean marginal bone levels at endo retreatment/ implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group (sig.).

•One year after completion of the treatment, teeth lost on average 0.32 ± 0.53 mm and implants 0.48 ± 0.72 (not sig.).

•One year after completion of the endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening.

•Two of the teeth originally without a lesion developed a lesion.

•No significant differences for the number of patients’ visits.

•It took significantly more days to complete the implant rehabilitation but less patients’ chair time.

•Implant treatment was significantly more expensive.

Clinical significance:

Results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates.