ABSTRACT
Introduction:
Initial root canal treatment and the replacement of a single tooth with implants are both viable treatment options, but various success rates have been reported for each treatment modality.
Materials and Methods:
This study compared 145 implant and 176 root canal treatment teeth in patients for four possible outcomes- success, survival, and failure.
Results:
Outcomes were as follows for root canal treatment and implant outcomes, respectively: success 75.56% and 80.00%; survival 18.18% and 11.72%; and failure 6.25% and 8.27%. The location of the restoration in the mouth did not affect the outcome.
Conclusion:
This study suggests that restored endodontically treated teeth and single tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.
KEYWORDS: Non-surgical root canal, single tooth implant, survival
INTRODUCTION
Natural dentition prevention in a patient remains an important outcome in securing oral health. Endodontic treatments have been shown to be successful in retaining compromised teeth that were fractured, carious, or traumatized, for many decades. Newer researches in implants provide greater choices for patients and clinicians, so the decision between root canal therapy and implant treatment is a commonly occurring dilemma in practice.[1]
From a clinician’s perspective, the outcome in terms of periapical healing or post-treatment disease is probably the most important as the periapical status of a treated tooth determines whether the ultimate goal of endodontic treatment has been achieved or not.[2] However, a relatively new measure, known as tooth survival, is considered to be more patient-centered and is more consistent with and comparable to that used in outcome studies of other treatment modalities, such as implant-supported restorations.[3]
Both implant and root canal treatment modalities have shown failures and complications. The outcome of single-tooth implant restorations was examined in a study with matched root canal-treated teeth that received a restoration.[4] Each treatment showed similar failure rates of approximately 6%, while the frequency of complications was found to be 18% for implants and 4% for root canal treatments. Periimplantitis was the most commonly reported complication in implant treatment, while persistent apical periodontitis was highly prevalent following endodontic treatment. Although both treatments are highly successful and predictable, root canal-treated teeth have been considered inferior to implants with respect to long-term survival.[5]
Modern dentistry should follow an evidence-based approach. However, the question of retention or extraction of a tooth has not been satisfactorily answered at a high level of evidence.[6] The decision-making process between tooth retention and extraction is difficult to investigate. A tooth may be functioning; however, multi-factorial risks may lead to extraction upon endodontic or restorative treatment attempts.[7]
Several factors have been assessed for potential association with each implant or root canal treatment modality, while a limited number of studies have compared implant and root canal therapy. Therefore, the primary aim of the current study was to assess and compare the survival rates of implant and root canal treatment.
METHODOLOGY
This retrospective study is carried out on patients who received root canal and implant treatment between April 2020 and March 2022 in our institution. The study was approved by the Institutional Review Board of the institution. Patients who have completed at least 18 years of age with a complete demographic and medical history in terms of age at the time of the procedure, gender, medical and tobacco history, tooth/implant site, and type of treatment were included and had received root canal treatment or implant treatment in the institution were included in the study.
All root canal treatments were performed in the Department of Endodontics while implants were surgically placed in the Dept. of Periodontology, Oral and Maxillofacial Surgery, and Prosthodontics. Treatment failure was defined as the removal of the implant or tooth for any reason since the most recent follow-up appointment. Records of completed root canals were taken which included region/tooth record of re-treatment and a record of all completed implant placement with the region was taken.
The root canal treatment and implant in patients were categorized for three possible outcomes- success, survival, and failure.
Implant failure was defined as the removal of a dental implant for any reason including loss of osseointegration, mobility, persistent pain, fracture, and extensive bone loss. Implants remained in situ at the time of the most recent follow-up with no indication for removal were considered survived. Root canal treatment failure was defined as a root canal-treated tooth that was extracted due to the presence of sinus tract, periapical radiolucency, pain following percussion tests, widening of the periodontal ligament, bone disturbance or loss, and signs and symptoms of root resorption or apical periodontitis. Root canal-treated teeth that remained in the oral cavity and were not planned for extraction at the time of the most recent follow-up were considered survived. Site characteristics included information about the arch (maxilla/mandible) and region (anterior/posterior). Premolars and molars were considered posterior, while canines and central and lateral incisors were grouped as anterior teeth.
Means, standard deviations, and percentages were presented as descriptive statistics. Demographic, site, and patient characteristics were summarized between root canal and implant treatment including gender, socioeconomic status, site characteristics as well as systemic medical conditions, and tobacco use. All data were analyzed with SPSS 24 (SPSS Inc. IMB) and statistical significance was set at the 0.05 level.
RESULTS
A total of 321 (100%) cases were included in this retrospective study was conducted over a period of 2 years in which 176 (53.12%) were root canal treatment and 145 (46.87%) were implanted. The demographic, site, and arch of root canal treatment and implant treatment as well as the total population are shown in Table 1. The mean age of patients in the root canal treatment group was 47.23 ± 2.34 while in the implant group, it was found to be 49.54 ± 1.87. There was a significant difference (P = 0.04) in tobacco usage in both groups.
Table 1.
Demographic and patient characteristics of the root canal treatment and implant groups
| Characteristics | Root canal treatment (176) | Extraction (145) | P |
|---|---|---|---|
| Age | 47.23±2.34 | 49.54±1.87 | <0.001* |
| Gender | |||
| Male | 93 (28.97%) | 81 (25.23%) | 0.127 |
| Female | 83 (25.85%) | 64 (19.93%) | |
| Tobacco use | |||
| Yes | 36 (11.21%) | 35 (10.90%) | 0.04* |
| No | 140 (43.61%) | 110 (34.26%) | |
| Arch | |||
| Maxilla | 78 (24.29%) | 68 (21.18%) | 0.321 |
| Mandible | 98 (30.52%) | 77 (23.98%) | |
| Region | |||
| Anterior | 54 (16.82%) | 41 (12.77%) | 0.05* |
| Posterior | 122 (38.00%) | 104 (32.39%) | |
| Outcome | |||
| Survival | 165 (51.40%) | 133 (41.43%) | 0.486 |
| Failure | 11 (3.42%) | 12 (3.73%) | |
| Medical history | |||
| Yes | 26 (8.09%) | 27 (8.41%) | 0.03* |
| No | 150 (46.72%) | 118 (36.76%) |
Out of 176 root canal treatments, 133 were successful while 32 had satisfactorily survived and the rest 11 treatments failed due to fractures, secondary caries, lack of clinical expertise, and compromised tooth condition. The mean survival rate of the root canal group was 93.75%. Out of 145 implant placements, 116 were successful while 17 had satisfactorily survived and the remaining 12 treatments [Figure 1] failed due to loosening of the implant, bad oral hygiene, lack of clinical expertise, and compromised tooth condition. The mean survival rate of the implant placement group was 91.72%. There was no statistically significant difference between the survival and failure rate of root canal treatment and dental implants [Table 2].
Figure 1.
Graph showing success and survival rates of root canal treatment and implant groups
Table 2.
Comparison of success and survival rates of root canal treatment and implant groups
| Characteristics | Root canal treatment | Implant | P |
|---|---|---|---|
| Success rate | 133 (75.56%) | 116 (80.00%) | 0.213 |
| Survival | 32 (18.18%) | 17 (11.72%) | 0.365 |
| Failure | 11 (6.25%) | 12 (8.27%) | 0.612 |
DISCUSSION
This study retrospectively compared the outcome of endodontically treated teeth and single implants in patients who received treatment between 2020 and 2022 over a period of 2 years. Different criteria have been used to evaluate the success rates of implants and root canal treatments. The success of root canal therapy requires resolution of periapical pathology, asymptomatic responses, and clinical function, while evaluation of implants has primarily been based on their osseointegration with or without peri-implantitis or loss of bone, which is considered survival and not success.[8] The comparison between root canal and implant treatment outcomes remains a challenge, especially when treatment success is evaluated. In the current study, the aim was to assess the survival rates of implant and root canal treatments. With respect to implant survival rates, a 92% rate has been reported for implants in a large-scale study.[9] However, an epidemiological study that used data from 1,462,936 root canal treatments from a dental insurance company reported a survival rate of 97%, 8 years following initial non-surgical root canal treatment.[10] In the current study, root canal treatment showed a 93.75% survival rate over 2 years which was not significant (P = 0.21) than following implant therapy (91.72%). This is in agreement with a meta-analysis that reported no significant differences between single-unit implants (95%) and root canal treatment (94%) over a 6-year observation time.[11]
A number of studies have examined the effect of systemic medical conditions on the survival rates of dental implants. Contraindications for implant treatment have been suggested in the literature for patients with osteoporosis, human immunodeficiency virus, cardiovascular disease, hypothyroidism, bleeding disorders, and diabetes, but there is still limited and inconclusive evidence.[12] The present study found a statistically significant association of age (P < 0.001) with root canal and implant treatment failure outcomes. Increasing age, diabetes, and hypertension have been associated significantly with reduced survival of root canal-treated teeth in a large epidemiological 10-year study in a Native American population.[13]
The results of this study provide valuable information in regard to treatment outcomes following root canal and implant treatment. Treatment failure results in a financial burden for the patient and frustration for both patient and clinician. Identification of factors associated with treatment failures could assist dental professionals in treatment planning.
CONCLUSION
The results of this retrospective study showed that implant therapy and root canal treatment do not have any significant difference in terms of treatment outcome, but the selection of either treatment should be based on factors like the condition of the tooth, cost of treatment, systemic condition of the patient, local factors, and tobacco use.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Mordohai N, Reshad M, Jivraj S, Chee W. Factors that affect individual tooth prognosis and choices in contemporary treatment planning. Br Dent J. 2007;202:63–72. doi: 10.1038/bdj.2007.23. [DOI] [PubMed] [Google Scholar]
- 2.Friedman S, Mor C. The success of endodontic therapy—healing and functionality. J Can Dent Assoc. 2004;32:493–503. [PubMed] [Google Scholar]
- 3.Ng Y-L, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: A systematic review of the literature. Int Endod J. 2010;43:171–89. doi: 10.1111/j.1365-2591.2009.01671.x. [DOI] [PubMed] [Google Scholar]
- 4.Doyle SL, Hodges JS, Pesun IJ, Law AS, Bowles WR. Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants. Compend Contin Educ Dent. 2007;28:296–301. [PubMed] [Google Scholar]
- 5.Ruskin JD, Morton D, Karayazgan B, Amir J. Failed root canals: The case for extraction and immediate implant placement. J Oral Maxillofac Surg. 2005;63:829–31. doi: 10.1016/j.joms.2005.02.018. [DOI] [PubMed] [Google Scholar]
- 6.Iqbal MK, Kim S. For teeth requiring endodontic treatment, what are the differences in outcomes of restored endodontically treated teeth compared to implant-supported restorations? Int J Oral MaxillofacImplants. 2007;22:96–116. [PubMed] [Google Scholar]
- 7.Wolcott J, Meyers J. Endodontic re-treatment or implants: A contemporary conundrum. Compend Contin Educ Dent. 2006;27:104–10. [PubMed] [Google Scholar]
- 8.Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GP. Success criteria in implant dentistry: A systematic review. J Dent Res. 2012;91:242–8. doi: 10.1177/0022034511431252. [DOI] [PubMed] [Google Scholar]
- 9.Boioli LT, Penaud J, Miller N. A meta-analytic, quantitative assessment of osseointegration establishment and evolution of submerged and non-submerged endosseous titanium oral implants. Clin Oral Implants Res. 2001;12:579–88. doi: 10.1034/j.1600-0501.2001.120605.x. [DOI] [PubMed] [Google Scholar]
- 10.Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: An epidemiological study. J Enndod. 2004;30:846–50. doi: 10.1097/01.don.0000145031.04236.ca. [DOI] [PubMed] [Google Scholar]
- 11.Iqbal MK, Kim S. For teeth requiring endodontic treatment: What are the differences in outcomes of restored endodontically treated teeth compared to implantsupported restorations? Int J Oral Maxillofac Implants. 2007;22:96–116. [PubMed] [Google Scholar]
- 12.Gómez-de Diego R, Mang-de la Rosa Mdel R, Romero-Pérez MJ, Cutando-Soriano A, López-Valverde-Centeno A. Indications and contraindications of dental implants in medically compromised patients: Update. Med Oral Patol Oral Cir Bucal. 2014;19:e483–9. doi: 10.4317/medoral.19565. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Mindiola MJ, Mickel AK, Sami C, Jones JJ, Lalumandier JA, Nelson SS. Endodontic treatment in an American Indian population: A 10-year retrospective study. J Endod. 2006;32:828–32. doi: 10.1016/j.joen.2006.03.007. [DOI] [PubMed] [Google Scholar]