Implants versus Endodontics: The Importance of Proper Treatment Planning

Tooth Root Model

Earlier forms of dentistry would normally promote extracting diseased or traumatized teeth, but nowadays, extraction has become more discouraged than ever unless it becomes a last resort. Practically all dentists today work to preserve their patient’s teeth as much as possible, and extraction is only ever considered an option for patients faced with financial considerations and limited treatment options. When addressing diseased teeth, dentists have developed numerous ways to address the inherent problem, and one of the top two recommendations for treating these teeth is through either implant or endodontic therapy. While both of these treatments can provide successful results, the planning process is what ultimately determines which treatments would be used and how both endodontists and implant dentists respond to their patients.

What Truly Determines Treatment Planning For Compromised Teeth?

Dentists often face a very unclear choice on whether to preserve a compromised tooth or remove the tooth entirely. In these blurry circumstances, compromised teeth present a common dilemma for restorative dentists and endodontists as diagnostics rely on straightforward, consistent answers backed by evidence. In these cases, those decision-making processes aren’t always clearly defined, and as emerging trends in dentistry attempt to work towards retaining natural tooth function, developments such as osseointegrated implants have started challenging the notion of what preservation means for dentists.

According to most guidelines stated by the ADA and other governing organizations, if the tooth is intact, then endodontic treatment should be performed. However, treating compromised teeth tends to lack the evidence and support for endodontic treatment, especially if the tooth is facing “end-stage” failure. End-stage failures are teeth that are unable to support minimally invasive reconstructive therapies due to their pathologic infections and lack of structural integrity. Compromised teeth represent the defining point between preserving healthy tooth structure and complete end-stage failure. Because of this, the influx of treatment options has created waves of divergence among dentists in their ability to fully recommend the right treatment for their patients while reducing the risk of treatment failure.

Because of these vast, complex issues presented with compromised teeth, there’s an argument to be made for both implants and endodontic therapy, as both of these treatments offer similar benefits, almost to the point where these treatments cancel each other out. In this case, implants and endodontic therapy have to be compared based on the factors that influence their treatment planning sessions. As these factors are considered, the list described below will hopefully provide dentists with the best decisions for them when considering either osseointegrated implants or endodontic therapy.

What Factors Help Dentists Choose Between Implants and Endodontic Therapy?

Both osseointegrated implants and endodontic therapy have become the primary treatment options for treating compromised teeth. For dentists considering their options, dentists should make sure to consider all factors involved before recommending either treatment option. These factors include:

  • Survival Rates: Survival rates are essential in the decision-making process and are also one of the most debated aspects of assessing treatments. When it comes to an overall average success rate, both implants, and endodontic therapy measure the same, as both of these methods rely on retention to be successful, one of the biggest problems evading this factor is how studies label and define their evaluation criteria. This leaves an inconsistent definition of what survival rates mean, as studies in endodontics are uniquely different from studies in implants. A factor that can be noted in measuring survival rates is the environmental framework that these studies take place in. Most often, endodontic treatments are often used in the presence of active disease, while implants are generally performed in the context of good oral health with the presence of already deteriorating teeth.
  • Patient Factors: Patients are the unique factor that determines all treatments, and for dentists looking at their patients, it’s important to learn about their patient’s expectations. These expectations can sometimes matter more so than the clinical implications, and it’s important for patients to be informed of any possible consequences and risks with their treatment. Patients that want to save their teeth may not comprehend the consequences of their treatment, what it entails, and their success rates compared to the average. Beyond these expectations, other patient-related factors regarding growth phases, patient health conditions, medication reactions, and oral hygiene compliance are also areas to look into when making a decision.
  • Aesthetic Concerns: Within the last 20 years, aesthetics has now become a huge treatment factor that dentists need to consider when choosing treatment. Endodontic therapy, while it can help preserve teeth, can also lead to an unaesthetic result. Implant studies provide an overall attractive appearance firsthand, but when placed incorrectly can cause drastic consequences to aesthetics, including failures such as implant malpositioning and soft tissue recession. Overall, while natural tooth preservation can achieve aesthetics through methods such as tooth shade matching, how the patient reacts to their treatment can also lead to negative results.
  • Financial Status: One conversation less commonly talked about among dentists is the financial considerations of their patients. Financial affordability can influence the decision-making process for patients and even some dentists. For instance, implant procedures tend to be more expensive than endodontic therapy, and other procedures may be needed to prepare the area for implant placement, which can steadily increase the costs over time. However, some may argue that endodontic therapy can offer a more cost-effective solution if all other factors are met.
  • Risks and Complexity: The risk assessment and rate of complexity with compromised teeth is an ever-evolving conversation, where factors outside of the dentists’ expertise, including prosthodontic, endodontic, and periodontal factors, need to be considered. If the tooth is questionable, then extraction may present a safer alternative if the tooth has a high risk of failure. While endodontic therapy can preserve the natural tooth, it alone doesn’t always guarantee long-term success. This is especially true if conditions such as periodontal disease, tooth fractures, and extensive decay are also present. In some cases, endodontic therapy can also create potential issues for implant placement later on, especially if the patient has bone reabsorption and soft-tissue reconstruction.

Overall, it is the responsibility of the dentist to help patients make the final decision regarding their oral health, and while both implants and endodontic therapy present many advantages and disadvantages, each patient’s smile always requires a unique approach that doesn’t always need to match the standard form of treatment. 

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