Keeping your natural teeth, even if they have had a root canal, is always the best option. Implants are a great option if you already have missing teeth, or if there is no way that a tooth can be saved. If you are given a choice between a root canal and an implant, choose root canal. Read on to learn more, and thanks for visiting Endostoch of Palm Beach, Florida.
The introduction of dental implants has proved to be a pivotal technology in dentistry. In a profession that strives to help patients keep their dentition, the point when it becomes necessary to opt for dental implants is a judgment call. Now, a new critical review published in the Journal of Dental Research comparing the long-term survival of implants and teeth that have been treated endodontically can help clinicians gain perspective on the two options (January 2014, Vol. 93:1, pp. 19-26).
“Both options should be seen as complementing each other, not as competing, and should serve the overall goal in dentistry, the long-term health and benefit of the patient, being least invasive and incorporating function, comfort, and esthetics,” the authors from the University of Pennsylvania wrote. “A tendency exists toward a simplified approach of ‘extraction and implant,’ but this is not always simple or ethical.”
Retention vs. replace
The researchers sought to examine the issue of “retention versus replace,” as well as endodontic therapy misconceptions, and analyze current endodontic treatment planning strategies for long-term success and tooth retention.
“Evidence exists that the loss rate of implants is higher than that of natural teeth in clinically well-maintained patients,” they wrote.
Comparing the two treatments is inherently difficult: “The implant field lacks a singular definition of success,” the authors noted, and many of the studies they examined opted instead to use “survival” as a study end point, giving them more opportunities for positive results.
“This is significant,” the authors explained, “because a distinct difference exists between outcome rates obtained from success vs. survival analysis.” In one study, the researchers found cumulative survival in 92% of 1,022 implants observed over a seven-year period, while cumulative success was only 83% (International Journal of Oral & Maxillofacial Implants [JOMI], September/October 2000, Vol. 15:5, pp. 691-700).
Another study from the same journal found similarly significant disparities in survival and success rates of implants, as shown in the chart below (JOMI, March/April 2004, Vol. 19:2, pp. 247-259).
In fact, some “ailing” or “failing” implants are categorized as successful in certain studies, the authors cautioned.
“Based on the critical evaluation of published data and methods used in clinical studies, reported outcome rates for implants may be greatly inflated,” they wrote.
In addition, the researchers found a lack of funding disclosures in 63% of industry-sponsored implant trials, while 66% had a risk of bias. The authors warned against using a success or survival rate of more than 95% for implants as a promotional tool, and noted that applying that figure to the general population “is erroneous information, because these values stem from ideal situations.”
Meanwhile, there are strict guidelines for endodontic success.
“If a positive outcome for teeth was defined as retention without symptoms, regardless of the periapical status, the survival of endodontically treated teeth is as high as that of implants,” the authors explained. As an example, they cited a meta-analysis that found a survival rate of 95% in restored single-unit implants and 94% of endodontically treated teeth in a six-year period (JOMI, 2007, Vol. 22:suppl, pp. 96-116).
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