A new critical review published in the Journal of Dental Research compares the long-term survival of implants and teeth that have been treated endodontically.
“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 aesthetics,” 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.”
The researchers set out to examine the issue of ‘retention versus replace’, although they point out that comparing the two treatments is difficult because “the implant field lacks a singular definition of success”, and that 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 because a distinct difference exists between outcome rates obtained from success vs. survival analysis,” the authors said.
“Based on the critical evaluation of published data and methods used in clinical studies, reported outcome rates for implants may be greatly inflated,” they added.
The authors compared the prognosis for implants and endodontically treated teeth, and noted that “natural teeth exceed the life expectancy of implants at 10-year observation points, including endodontically treated or periodontally compromised teeth.”
The authors conclude that endodontic treatment has improved significantly over the last 20 years and that “too many teeth are extracted in favour of implants, since extraction is perceived as easier and more lucrative than saving a natural tooth.” Clinicians should remember that “teeth with moderate vertical bone loss, even with furcation involvement, have a good prognosis if proper treatment is rendered.”