ORAL IMPLANTOLOGY
IMPLANT THERAPY DECISIONMAKING FOR ENDODONTICALLY
INVOLVED DENTITION
Cite this article:
Monje A, Suarez-Lopez del Amo F,
Garaicoa CA, Nieto-Salas J, Tang Z,
Fu JH, Wang HL. Decision-making
on Implant Therapy for
Endodontically Involved Tooth
Stoma Edu J. 2015;2(1):10-16
Alberto Monje1a,
Fernando Suarez-Lopez del Amo1a,
Carlos Andrés Garaicoa1b,
Javier Nieto-Salas2c,
Zhihui Tang3d,
Jia-Hui Fu4e,
Hom-Lay Wang1f*
1. Department of Periodontics and Oral Medicine,
School of Dentistry, University of Michigan,
Ann Arbor, MI, USA
2. Department of Endodontics, School of Dentistry
European University of Madrid, Madrid, Spain
3. 2nd Clinical Division, School of Stomatology
Peking University, Beijing, China
4. Discipline of Periodontology, Faculty of Dentistry
National University of Singapore, Singapore
a. DDS, Resident, Graduate Periodontics
b. DDS, Visiting Scholar, Graduate Periodontics
c. DDS, Professor
d. DDS, PhD, Professor, Director
e .DDS, MS, Assistant Professor
f. DDS, MS, PhD, Professor, Director
Received: 12 May 2015
Accepted: 1 June 2015
* Corresponding author:
Hom-Lay Wang DDS, MSD, PhD
Professor and Director of Graduate Periodontics
Department of Periodontics and Oral Medicine
School of Dentistry, University of Michigan
1101 N. University, Ann Arbor,
MI 48109-1078, USA
Tel: 734-763-3383; Fax: 734-936-0374
Email: homlay@umich.edu
56
Abstract
This article proposes an evidence based decision tree that serves to guide clinicians
on the feasibility of endodontic treatment of a non-vital tooth. It is a reference that
clinicians can use when deciding to save or extract a non-vital tooth. Several factors
that are commonly encountered in daily practice are considered in this proposed
decision-making process and they are history of endodontic treatment, status of
previous endodontic treatment, presence/absence of active infection, size of apical
radiolucency, periodontal status and patient´s preference.
Keywords: endosseous dental implant, endodontic treatment, root canal,
evidence-based science, decision-making
Introduction
In dentistry, preserving natural dentition
is the primary goal of every clinician.
However, dental diseases such as caries and
periodontitis may influence the fate of the
involved tooth. When caries or periodontitis
affect pulpal health, endodontic therapy is
required, whereby diseased pulpal tissue
is removed and the root canal system is
sealed from within the tooth. With current
technology, 94 – 97% of endodontically
treated teeth have remained functional over
3.5 to 8 years post treatment (1, 2), indicating
high long-term success rates. Despite this,
some clinicians may opt to extract the tooth
and replace it with a dental implant. This is
because heterogeneity in success criteria
and methodology exist among studies
resulting in a lack of conclusive evidence to
support the favorable long-term prognosis
of endodontically treated teeth (3).
Studies with the strictest success criteria in
endodontic treatment reported low success
rates of 52 – 54% after 6 – 10 years (4, 5).
The failure of endodontic teeth could be
attributed to lack of sound tooth structure
for cuspal protection, vertical root fracture,
iatrogenic perforations and periodontal
disease (6).
Prior to initiating endodontic therapy, the
periodontal health and restorability of the
involved tooth has to be evaluated. This is
because periodontal status can adversely
affect the long-term survival of the tooth.
Assessing the long-term prognosis of a
tooth is complex because it is an interplay
of a myriad of factors. As such, a decision
tree that evaluated 6 different factors,
namely initial assessment, severity of
periodontal disease, furcation involvement,
etiologic factors, restorative status, and
other determinants, was proposed to help
clinicians decide when it is preferred to save
or extract a tooth (7).
It has been reported that financial
considerations, and the belief that dental
implants may offer better long-term stability
are the main reasons for the choice of
implants over endodontic treatment (6, 8).
However, in certain clinical scenarios e.g.
medically compromised patients, those who
are at risk of osteonecrosis, sites that will
require extensive surgical management in
terms of hard and soft tissue augmentation
after tooth loss, implant therapy may not be
feasible. In these cases, clinicians may be
more inclined to retain the involved with
endodontic and prosthodontics therapies
instead of removing the tooth and restoring
with an implant prosthesis. Therefore,
the purpose of this paper is to propose a
decision tree, based upon current evidence,
for determining when to proceed with
endodontic treatment or tooth removal and
replacing it with a dental implant.
STOMA.EDUJ (2015) 2 (1)