It is easy to forget in today’s debate that competently performed endodontic therapy is one of the most predictable dental therapy forms available, with a well documented superb long-term retention of endodontically treated teeth
Dental implants are excellent treatment options in cases when natural teeth have been lost and require replacement
However, the erroneously perceived high rate of treatment success when inserting single tooth implants compared with endodontic treatment has, in recent years, often biased the general dentist’s objectivity when selecting treatment options
Minor concerns about endodontic treatment outcomes often lead to unnecessary tooth extractions and replacement with implants
Many currently published recommendations for extraction of endodontically treated teeth show a stunning ignorance about endodontic treatment outcomes
Surprisingly few official comments have been raised from the organized endodontic community to discuss this dissonance
Instead the American Association of Endodontists has clearly taken a subservient role in this discussion and issued some what ambivalent policy statements
In scientific studies of endodontic treatment outcomes, definitive unambiguous endpoints must be defined to describe treatment results
Such criteria were defined by Strindberg and have become the gold standard for outcome studies
Thus, after sufficient follow-up time, “success" (satisfactory healing) is described as a complete healing of the periradicular bone with a normal periodontal ligament and lamina dura
Teeth with failed endodontic treatment are often candidates for some form of retreatment to achieve complete elimination of periradicular disease
However, a case is often made that these teeth, scheduled for retreatment, are at high risk of repeated failure
This misunderstanding has resulted in an ever-ending large pool of teeth being candidates for single tooth implants identified by uncritical interests
There is ample evidence that in most of these cases, other treatment options are available to maintain a restorable tooth
It is somewhat difficult to understand how we got into this untenable position
Poor communication between various “guilds” of dental specialists and other interest groups is certainly one important factor
The scientific evaluation of successful endodontic treatment requires that the Strindberg criteria of complete bone healing remain the gold standard
For clinical purposes and in the daily assessment of treatment outcome, some “looser” terms, such as “healing" "functional” and “retained” may be more useful descriptions
For implant assessments, however, even the most fastidious evaluator is likely
to use “retained” as a characterization of good outcome
Confusion arises when less than precise clinical criteria of implant treatment are used to compare results when strict scientific endodontic criteria were applied
As a result, it is often wrongly stated that the long-term treatment success rate is equal for endodontic treatment and a single tooth implant
According to many recent reports on the outcomes of endodontic treatment, there are very few teeth that cannot be retained if the full scope of endodontic treatment options issued
Dental implants have been used for many years but not until recently have relatively objective studies of long-term outcomes been available in the literature
The endpoint descriptor in implant studies is often unclear and the desirable result often characterized as a retained implant
It is also rather clear that implants tend to fail in increasing numbers with time
With a 7-year retention rate close to 90% and with more stringent success criteria the rate falls to 83% again
Still, implants with signs of peri-implant infection and maintained by adapted antimicrobial treatment were not considered to be failures in that study
This is a positively biased attitude to peri-implantitis, because it is a difficult to treat chronic pathologic condition with a low rate of long-term success
Similar treatment results have been reported by others
The most convincing value of endodontic treatment is its long-term success and permanence
A periapical lesion that heals after a quality treatment, followed by proper restorative maintenance, will not fail later due to endodontic reasons
Endodontic treatment results are also improving with time
Several studies published during recent years have assessed the retention rate of endodontically treated teeth, those studies show how endodontically treated teeth are retained at
Teeth with failed endodontic treatment are often candidates for some form of retreatment to achieve complete elimination of periradicular disease
However, a case is often made that these teeth, scheduled for retreatment, are at high risk of repeated failure
This misunderstanding has resulted in an ever-ending large pool of teeth being candidates for single tooth implants identified by uncritical interests
There is ample evidence that in most of these cases, other treatment options are available to maintain a restorable tooth
It is somewhat difficult to understand how we got into this untenable position
Poor communication between various “guilds” of dental specialists and other interest groups is certainly one important factor
The scientific evaluation of successful endodontic treatment requires that the Strindberg criteria of complete bone healing remain the gold standard
For clinical purposes and in the daily assessment of treatment outcome, some “looser” terms, such as “healing" "functional” and “retained” may be more useful descriptions
For implant assessments, however, even the most fastidious evaluator is likely
to use “retained” as a characterization of good outcome
Confusion arises when less than precise clinical criteria of implant treatment are used to compare results when strict scientific endodontic criteria were applied
As a result, it is often wrongly stated that the long-term treatment success rate is equal for endodontic treatment and a single tooth implant
According to many recent reports on the outcomes of endodontic treatment, there are very few teeth that cannot be retained if the full scope of endodontic treatment options issued
Dental implants have been used for many years but not until recently have relatively objective studies of long-term outcomes been available in the literature
The endpoint descriptor in implant studies is often unclear and the desirable result often characterized as a retained implant
It is also rather clear that implants tend to fail in increasing numbers with time
With a 7-year retention rate close to 90% and with more stringent success criteria the rate falls to 83% again
Still, implants with signs of peri-implant infection and maintained by adapted antimicrobial treatment were not considered to be failures in that study
This is a positively biased attitude to peri-implantitis, because it is a difficult to treat chronic pathologic condition with a low rate of long-term success
Similar treatment results have been reported by others
The most convincing value of endodontic treatment is its long-term success and permanence
A periapical lesion that heals after a quality treatment, followed by proper restorative maintenance, will not fail later due to endodontic reasons
Endodontic treatment results are also improving with time
Several studies published during recent years have assessed the retention rate of endodontically treated teeth, those studies show how endodontically treated teeth are retained at
about 95%-97% after 8 years compared with 85%-90% for implant retention during a similar time period
It is also important to notice that implant data available today are from carefully controlled clinical studies with intensive maintenance
No objective long-term data are available on implant survival in a general dental practice setting
On the other hand, endodontic numbers discussed here are retention data from average non specialized dentists
Complications after restorative procedures, such as root fractures, are often mentioned as a strong negative factor against restoring and preserving endodontically treated teeth
However, these treatment complications may be more associated with substandard prosthetic work and poor material choices than with an endodontic complication
In a recent follow-up study of a substantial patient material, the life span of well constructed full crowns on cast posts was equal or higher than full crowns on teeth with vital pulp
Implant is an excellent treatment option for the replacement of a missing tooth However, it should never be an option for the replacement of an existing restorable tooth
It is also important to notice that implant data available today are from carefully controlled clinical studies with intensive maintenance
No objective long-term data are available on implant survival in a general dental practice setting
On the other hand, endodontic numbers discussed here are retention data from average non specialized dentists
Complications after restorative procedures, such as root fractures, are often mentioned as a strong negative factor against restoring and preserving endodontically treated teeth
However, these treatment complications may be more associated with substandard prosthetic work and poor material choices than with an endodontic complication
In a recent follow-up study of a substantial patient material, the life span of well constructed full crowns on cast posts was equal or higher than full crowns on teeth with vital pulp
Implant is an excellent treatment option for the replacement of a missing tooth However, it should never be an option for the replacement of an existing restorable tooth
A recent literature review and meta-analysis found that natural teeth surrounded by healthy periodontal tissues yield a very high
longevity of up to 99.5% over 50 years
Periodontally compromised teeth that are treated and maintained regularly have a rate of 92%-93 % in survival
That study concluded that oral implants, when evaluated after 10 years of service do not surpass the longevity of even compromised but successfully treated natural teeth
Therefore, an implant should not be a treatment alternative for teeth that a reasonable competent dentist can restore and care for
Endodontic orthograde or retrograde treatment should always be the first treatment choice of a tooth having ongoing endodontic disease
Periodontally compromised teeth that are treated and maintained regularly have a rate of 92%-93 % in survival
That study concluded that oral implants, when evaluated after 10 years of service do not surpass the longevity of even compromised but successfully treated natural teeth
Therefore, an implant should not be a treatment alternative for teeth that a reasonable competent dentist can restore and care for
Endodontic orthograde or retrograde treatment should always be the first treatment choice of a tooth having ongoing endodontic disease
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