Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review.

Purpose:

Compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement.

Materials/Methods:

N=143 articles

Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation.

Results:

  • The studies varied considerably in design, success definition, assessment methods, operator type, and sample size.
  • Direct comparison of treatment types was extremely rare.
  • Success rates for ISCs were higher than for crowns on RCTx and FPDs, respectively
  • Success criteria differed greatly among treatment types, making direct comparison of success rates impossible.
  • Long-term survival rates for ISCs and RCTx were similar and superior to those for FPDs.
  • “Initial endodontic treatment has high long-term survival rate for periodontally sound teeth that have pulpal and/or periapicalpathosis.”

Clinical Significance:

Implants and RCTx both have high success rates compared to ext and FPD placement.

Comparison of nonsurgical root canal treatment and single-tooth implants

Purpose:

  • Compare the differences between nonsurgical root canal treatment and single-tooth implants.

Materials/Methods:

  • An extensive search of the dental literature was accomplished to identify publications related to the differences in root canal therapy and dental implants.

Results:

  • Success / survival rates for implants and RCT are similar
  • Tooth retention through RCT and restoration or tooth replacement with an implant resulted in superior clinical outcomes psychologically than did extraction without replacement.
  • Endodonticallytreated teeth are associated with less complications and procedural interventions than implant-supported crowns and that complications associated with implant failure significantly impact a patient more negatively than when endodontically treated teeth fail.
  • From an economic point of view, endodontic treatment might be a more favorable treatment option compared with implant-supported crowns.

Clinical Significance:

With the reviewed information in hand, the practitioner should be better prepared to determine which treatment option is most appropriate for each individual patient.

Comparison of success of implants versus endodontically treated teeth

Purpose:

  • Compare the success of implants and NSRCT, with minimal subjective grading.

Materials/Methods:

  • N= 129 implants, 143 NSRCT.
  • Implant data collected from a Periodontic practice, and RCTx data collected from Endodontic practice. Outcome was determined by clinical chart notes and radiographs. Followed up an average of 36 months. Failure was defined as removal of the implant or tooth. Success was recorded if the implant or tooth was in place and functional.

Results:

  • Implant success rate of 98.4%.
  • NSRCT success rate of 99.3%.
  • No statistically significant differences were found
  • When uncertain findings were added to the failures, implant success dropped to 87.6%, and endodontic success declined to 90.2%. (difference not SS)
  • 12.4% of implants required interventions, whereas 1.3% of endodontically treated teeth required interventions – statistically significant

Clinical Significance:

The success of implant and endodontically treated teeth was essentially identical, but implants required more postoperative treatments to maintain them

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants.

Purpose:

  • Compare implant restorations and NSRCT teeth in patients for four possible outcomes- success, survival, survival with subsequent treatment intervention and failure.

Materials/Methods:

  • N= 196 implant restorations and 196 matched initial NSRCT teeth.
  • Data obtained from University of Minnesota (1993-2002). Treatment carried out by dental students, graduate residents, or staff clinicians. 1 year recall.

Results:

  • Outcomes were as follows for implants and NSRCT outcomes, respectively:
  1. Success 73.5% and 82.1%;
  2. Survival with no intervention 2.6% and 8.2%
  3. Survival with intervention 17.9% and 3.6%
  4. Failure 6.1% and 6.1%
  • Location of the restoration in the mouth did not affect outcome.

Clinical Significance:

This study suggests that restored endodontically treated teeth and single-tooth implant restorations have similar failure rates.

Delayed root canal therapy: an analysis of treatment over time.

Purpose:

  • The study was performed to compare immediate (defined as completion of root canal treatment within a period of 4 months (120 days) or less) and delayed (defined as incomplete root canal therapy (never obturated) or completion of root canal therapy in a period of time greater than 4 months).

Materials/Methods:

  • N=898 teeth.
  • Data taken from military dental clinic. Endodontists and general dentists provided treatment. Comparisons of prompt and delayed treatment groups were made with regard to preoperative pain, interappointment emergencies, postobturation pain, and final treatment.

Results:

  • Significantly higher incidence of inter-appointment emergency was observed for the delayed treatment group (21%) than for the prompt treatment group (8%)
  • 56% of teeth with incomplete root canal therapy eventually were extracted compared to 3% for the root canal filling treatment groups.

Clinical Significance:

Completion of RCT within a short time frame results in fewer inter-appointment emergencies.  Incomplete root canal therapy has a high failure/extraction rate.

A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival

Purpose:

  • To investigate the probability of and factors influencing tooth survival following primary or secondary root canal treatment.

Materials/Methods:

  • N= 759 primary RCTx, 858 secondary RCTx.
  • RCT carried out by post grad residents. Information about extraction of the root filled tooth was sought from the patient, the referring dentist or derived from the patient’s records and included the timing and reasons for extraction. Followed up for 2-4 years

Results:

  • Diabetes affected 1st RCT outcome and systemic steroid therapy affected retreatment.
  • If they did not have patency= less survival.
  • Extrusion of sealer did not affect the survival..
  • Perforation and cast post-core  lowered the survival
  • Significant post-operative restorative factors: presence of cast restoration versus temporary restoration; presence of cast post and core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth.
  • 4-year cumulative tooth survival following primary RCTx = 95.4%
  • Secondary RCTx  95.3%
  • The presence of pre-operative pain had a profound effect on tooth loss within the first 22 months after treatment with a lesser effect beyond 22 months
  • Extrusion of gutta-percha root filling did not have any effect on tooth survival within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months

Clinical Significance:

Tooth survival rate for both primary and secondary root canal therapy is 95% (many factors present).