Treatment planning: Retention of the natural dentition and the replacement of missing teeth

Scott L. Doyle

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Article: Treatment planning: Retention of the natural dentition and the replacement of missing teeth

Author: Scott L. Doyle, DDS

Learning Objectives:

  • Describe the reported survival rates of initial nonsurgical root canal treatment, retreatment and microsurgery. Compare these rates to those reported for single-tooth implants.
  • List factors that influence the decision-making process when treatment planning for endodontic treatment and single-tooth implants.
  • Discuss the importance of interdisciplinary consultation between general dentists and specialists.

The C.E. quiz will be available online, upon registration for this course.

For additional reading on the topic, please refer to:

1. Azarpazhooh A, Dao T, Figueiredo R, et al. A survey of patients’ preferences for the treatment of teeth with apical periodontitis. J Endod 2013;39:1534-41.

2. Gatten DL, Riedy CA, Hong SK, et al. Quality of life of endodontically treated versus implant treated patients: a university-based qualitative research study. J Endod 2011;37:903-9.

3. Baba NZ, Goodacre CJ, Kattadiyil MT. Tooth retention through root canal treatment or tooth extraction and implant placement: a prosthodontics perspective. Quintessence Int 2014;45:405-16.

4. Moraschini V, Poubel LA, Ferreira VF, et al. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a followup period of at least 10 years: a systematic review. Int J Oral Maxillofac Surg 2015;44:377-88.

5. Pjetursson BE, Asgeirsson AG, Zwahlen M, et al. Improvements in implant dentistry over the last decade: comparison of survival and complication rates in older and newer publications. Int J Oral Maxillofac Implants 2014;29(Suppl):308-24.

6. Avila G, Galindo-Moreno P, Soehren S, et al. A novel decision-making process for tooth retention or extraction. J Periodontol 2009;80:476-91.

7. Lindhe J, Pacey L. There is an overuse of implants in the world and an underuse of teeth as targets for treatment. Br Dent J 2014;217:396-7.

8. Levin L, Halperin-Sternfeld M. Tooth preservation or implant placement: a systematic review of long-term tooth and implant survival rates. J Am Dent Assoc 2013;144:1119-33.

9. Tomasi C, Wennström JL, Berglundh T. Longevity of teeth and implants – a systematic review. J Oral Rehabil 2008;35(Suppl 1):23-32.

10. Holm-Pedersen P, Lang NP, Mu?ller F. What are longevities of teeth and oral implants? J Clin Oral Implant Res 2007;18(Suppl 3):15-19.

11. Lundgren D, Rylander H, Laurell L. To save or extract, that is the question. Natural teeth or dental implants in periodontitis-susceptible patients: clinical decision-making and treatment strategies exemplified with patient case presentations. Periodontol 2000. 2008;47:27-50.

12. Pradeep K, Rajesh H, Rao PK, et al. Implant or root canal treatment: clinical guidelines and decision making. J Dent Implant 2013;3:67-72.

13. Zitzmann NU, Krastl G, Hecker H, et al. Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. Int Endod J 2009;42:757-74.

14. John V, Chen S, Parashos P. Implant or the natural tooth–a contemporary treatment planning dilemma? Aust Dent J 2007;52(Suppl 1):S138-50.

15. Torabinejad M, Salha W, Lozada JL, et al. Degree of patient pain, complications, and satisfaction after root canal treatment or a single implant: a preliminary prospective investigation. J Endod 2014;40:1940-5.

16. Treatment Options for the Compromised Tooth: A Decision Guide. American Association of Endodontists 2014.

17. Stockhausen R, Aseltine R Jr, Matthews JG, et al. The perceived prognosis of endodontic treatment and implant therapy among dental practitioners. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:42-7.

18. Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res 2014;93:19-26.

19. Strindberg LZ. The dependence of the results of pulp therapy on certain factors. An analytic study based on radiographic and clinical follow-up examinations. Acta Odontol Scand 1956;14(Suppl 21):1-175.

20. Papaspyridakos P, Chen CJ, Singh M, et al. Success criteria in implant dentistry: A systematic review. J Dent Res 2012;91:242-8.

21. Bhatavadekar N. Helping the clinician make evidence-based implant selections. A systematic review and qualitative analysis of dental implant studies over a 20 year period. Int Dent J 2010;60:359-69.

22. Implants. Position Statement of the American Association of Endodontists 2007.

23. Friedman S, Mor C. The success of endodontic therapy-healing and functionality. J Calif Dent Assoc 2004:32:493-503.

24. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod 2004;30:846-50.

25. Chen SC, Chueh LH, Hsiao CK, et al. An epidemiologic study of tooth retention after nonsurgical endodontic treatment in a large population in Taiwan. J Endod 2007;33:226-9.

26. Lazarski MP, Walker WA 3rd, Flores CM, et al. Epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients. J Endod 2001;27:791-6.

27. Ng YL, 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.

28. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J 2011;44:610-25.

29. de Chevigny C, Dao TT, Basrani BR, et al. Treatment outcome in endodontics: the Toronto study—phase 4: initial treatment. J Endod 2008;34:258-63.

30. Alley BS, Kitchens GG, Alley LW, et al. A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:115-18.

31. Dugas NN, Lawrence HP, Teplitsky P, et al. Quality of life and satisfaction outcomes of endodontic treatment. J Endod 2002;28:819-27.

32. Baba NZ, Goodacre CJ. Restoration of endodontically treated teeth: contemporary concepts and future perspectives. Endod Topics 2014;31:68-83.

33. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent 2002;87:256-63.

34. Gillen BM, Looney SW, Gu LS, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod 2011;37:895-902.

35. Patel S, Durack C, Abella F, et al. Cone beam computed tomography in endodontics – a review. Int Endod J 2015;48:3-15.

36. Ee J, Fayad MI, Johnson BR. Comparison of endodontic diagnosis and treatment planning decisions using cone beam volumetric tomography versus periapical radiography. J Endod 2014;40:910-6.

37. 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 Maxillofac Implants 2007;22(Suppl):96-116.

38. Torabinejad M, Anderson P, Bader J, et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. J Prosthet Dent 2007;98:285-311.

39. Doyle SL, Hodges JS, Pesun IJ, et al. Retrospective cross-sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants. J Endod 2006;32:822-7.

40. Hannahan JP, Eleazer PD. Comparison of success of implants versus endodontically treated teeth. J Endod 2008;34:1302-5.

41. Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy. J Endod 2008;34:519-29.

42. Torabinejad M, Goodacre CJ. Endodontic or dental implant therapy: the factors affecting treatment planning. J Am Dent Assoc 2006;137:973-7.

43. Doyle SL, Hodges JS, Pesun IJ, et al. Factors affecting outcomes for single-tooth implants and endodontic restorations. J Endod 2007;33:399-402.

44. Morris MF, Kirkpatrick TC, Rutledge RE, et al. Comparison of nonsurgical root canal treatment and single-tooth implants. J Endod 2009;35:1325-30.

45. Dawson DR 3rd, Jasper S. Key systemic and environmental risk factors for implant failure. Dent Clin North Am 2015;59:25-39.

46. Bowles WR, Drum M, Eleazer PD. Endodontic and implant algorithms. Dent Clin North Am 2010;54:401-13.

47. Wang CH, Chueh LH, Chen SC, et al. Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod 2011;37:1-5.

48. Mankani N, Chowdhary R, Patil BA, et al. Osseointegrated dental implants in growing children: a literature review. J Oral Implantol 2014;40:627-31.

49. Fuentealba R, Jofré J. Esthetic failure in implant dentistry. Dent Clin North Am 2015;59:227-46.

50. Reese R, Aminoshariae A, Montagnese T, et al. Influence of demographics on patients’ receipt

51. Christensen GJ. Implant therapy versus endodontic therapy. J Am Dent Assoc 2006;137:1440-3.

52. Pennington MW, Vernazza CR, Shackley P, et al. Evaluation of the cost- effectiveness of root canal treatment using conventional approaches versus replacement with an implant. Int Endod J 2009;42:874-83.

53. Kim SG, Solomon C. Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives. J Endod 2011;37:321-5.

54. Gerritsen AE, Allen PF, Witter DJ, et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.

55. Liu P, McGrath C, Cheung GS. Improvement in oral health-related quality of life after endodontic treatment: a prospective longitudinal study. J Endod 2014;40:805-10.

56. Pjetursson BE, Karoussis I, Bu?rgin W, et al. Patients’ satisfaction following implant therapy. A 10-year prospective cohort study. Clin Oral Implants Res 2005;16:185-93.

57. Zitzmann NU, Krastl G, Hecker H, et al. Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth. J Prosthet Dent 2010;104:80-91.

58. Goodacre CJ, Bernal G, Rungcharassaeng K, et al. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-32.

59. White SN, Miklus VG, Potter KS, et al. Endodontics and implants, a catalog of therapeutic contrasts. J Evid Based Dent Pract 2006;6:101-9.

60. Friedman S. Considerations and concepts of case selection in the management of post-treatment endodontic disease (treatment failure). Endod Topics 2002;1:54-78.

61. Torabinejad M, Corr R, Handysides R, et al. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod 2009;35:930-7.

62. Abbott P. Diagnosis and management planning for root-filled teeth with persisting or new apical pathosis. Endod Topics 2011;19:1-21.

63. Ng YL, Gulabivala K. Outcome of non-surgical re-treatment. Endod Topics 2011;18:3-30.

64. Salehrabi R, Rotstein I. Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment. J Endod. 2010;36:790-2. 65. Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod 2004;30:1-4.

66. Niemczyk SP. Essentials of endodontic microsurgery. Dent Clin North Am 2010;54:375-99.

67. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006;32:601-23.

68. Setzer FC, Shah SB, Kohli MR, et al. Outcome of endodontic surgery: a meta-analysis of the literature–part 1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod 2010;36:1757-65.

69. Torabinejad M, Landaez M, Milan M, et al. Tooth retention through endodontic microsurgery or tooth replacement using single implants: a systematic review of treatment outcomes. J Endod 2015;41:1-10.

70. Azarpazhooh A, Dao T, Ungar WJ, et al. Clinical decision making for a tooth with apical periodontitis: the patients’ preferred level of participation. J Endod 2014;40:784-9.

71. Silvestrin T. The role of implant dentistry in the specialty of endodontics. Endod Topics 2014;30:66-74.

72. Cohn SA. Treatment choices for negative outcomes with non-surgical root canal treatment: non-surgical retreatment vs. surgical retreatment vs. implants. Endod Topics 2005;11:4-24.

73. Torabinejad M, Sabeti M, Goodacre C. Principles and practice of single implant and restorations. W.B. Saunders Company, 2014.

Tribune Group GmbH is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Tribune Group designates this activity for 1 continuing education credits.
This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group GmbH and Dental Tribune International GmbH.

Fecha de comienzo: 30 abril 2016
Fecha de expiración: 30 abril 2019


Scott L. Doyle

Scott L. Doyle, DDS, MS received his BS from the University of Wisconsin-Madison in 1995 and his DDS from the University of Minnesota in 1999. He served in the United States Air Force for seven years, including an advanced education in general dentistry residency. Doyle obtained both his MS and Certificate in Endodontics from the University of Minnesota in 2004. He currently practices with Metropolitan Endodontics in Minneapolis and serves as an associate clinical professor for the Division of Endodontics at the University of Minnesota. Doyle is a Diplomate of the American Board of Endodontics. He is a past president of the Minnesota Association of Endodontists, chair of the AAE Continuing Education Committee, and serves as a reviewer for the Journal of Endodontics. Doyle has authored multiple articles in scientific journals, as well as a chapter on the “Endodontic Applications of CBCT” in an upcoming textbook.

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