Researchers evaluate root canals versus extraction and dental implants

A new study addresses the growing controversy among dental health professionals regarding the best course of treatment when evaluating between a root canal or dental implant procedure.

Researchers evaluated the success and failure rates of teeth treated with a root canal (endodontically treated teeth) or extracted and replaced with a dental implant. While the findings concluded that the success rate of each treatment was similar, the data showed that significantly more dental implants required additional treatment or surgical intervention after the procedure compared to endodontically treated teeth (12.4 percent versus 1.4 percent, respectively).

“Many dental professionals today are faced with the dilemma of whether root canal treatment or dental implants are the best option for their patients,” said lead investigator James Porter Hannahan, D.M.D., of the University of Alabama at Birmingham, Birmingham, AL. “While the success of both procedures is similar, saving the natural tooth through a root canal rarely requires follow-up treatment and generally lasts a lifetime; implants, on the other hand, have more post-operative complications and higher long-term failure rates.”

Research has shown that poor oral health and tooth loss may lead to serious medical conditions, such as heart disease, stroke, diabetes and even certain types of cancer. Given this connection, taking the right steps to prevent tooth loss can be important for maintaining better overall health.

“Considering these results in light of the growing body of evidence on the impact of oral health on overall health, it is imperative for dental professionals to partner with endodontists who have advanced training in examining whether a natural tooth can be saved through root canal treatment,” said Dr. Louis Rossman, an endodontist and president of the American Association of Endodontists (AAE), the dentists who specialize in root canals. “While implants may be an appropriate solution for people with missing teeth, endodontic treatment should be the first choice for restoring a compromised tooth.”

Because of the increasing popularity of dental implants, patients may not realize the long-term implications of the procedure or that root canals may be healthier and less complicated in the long-run. Dental professionals should ensure they explain to patients the differences between each procedure.

Dental implants require extracting the tooth followed by multiple surgeries to insert a metal post in the jaw and affix a porcelain crown to the post. These surgeries often can take three or more visits over the course of several months to complete and can be time-intensive and costly. During root canal treatment, the source of tooth pain – inflamed pulp – is removed and the inside of the tooth is then cleaned, filled and sealed. Today, most root canals can be completed in one visit and are virtually painless. In fact, root canals restore and save an average of 17 million teeth each year.

When considering treatment options, the AAE emphasizes that decisions must be based on factors other than outcome, such as case complexity or the patient's individual health and preferences. To assist dental professionals and their patients in determining the most appropriate treatment, the AAE has formal guidance on treatment planning, which includes evaluating various risk factors and other implications associated with root canal and implant treatment. Risk factors can include smoking, bone quality and estrogen levels – for example, women with lower estrogen levels may encounter more treatment failures with implants.

Additional Study Information

Based on inclusion criteria, study investigators evaluated patient charts of 129 dental implants for an average of 36 months (range, 15-57 months) and of 143 endodontically treated teeth for an average 22 months (range, 18-59 months). Implant data were collected from a periodontic group practice and root canal data were collected from an endodontic group practice. Researchers placed each procedure into one of three categories: success, uncertain and failure. Success was defined as radiographic evidence that the implant or treated tooth was still present in the mouth and there were no signs or symptoms requiring intervention during the follow-up treatment period. Failures were defined as the removal of the implant or tooth.

Investigators found two failures of the 129 dental implants for a success rate of 98.4 percent. They also found only one failure of the 143 endodontic treatments for a success rate of 99.3 percent. These results were not statistically significant (P=.56) with the Fisher exact test, a statistical significance test. However, 12.4 percent of the dental implants required additional interventions, whereas only 1.4 percent of the endodontically treated teeth required additional interventions, which was statistically significant (P=.0003).

This study is published in the November issue of the Journal of Endodontics , the official journal of the AAE. These data were collected as part of a larger project comparing implant and endodontic outcomes and is funded by the AAE Foundation.

About Endodontists

Endodontists complete a minimum of two additional years of advanced specialty education in diagnosis and root canal treatment. Endodontists use their special training and experience in assessing and treating compromised teeth. They may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform their services. Endodontists' advanced training and use of technology makes root canals virtually painless and helps people save their natural teeth.

About the American Association of Endodontists

The American Association of Endodontists, headquartered in Chicago, represents more than 7,100 members worldwide, including approximately 95 percent of all eligible endodontists in the United States. The AAE, founded in 1943, is dedicated to excellence in the art and science of endodontics and to the highest standard of patient care. The association inspires its members to pursue professional advancement and personal fulfillment through education, research, advocacy, leadership, communication and service.

http://www.aae.org or http://www.rootcanalspecialists.org