Root canal treatment and dental implants are both viable treatment options for replacing missing or compromised teeth. Success rates of each treatment are generally high, ranging from 92-97% for root canals and 95-99% for implants. Other factors beyond success rates must be considered, including patient characteristics, habits, concerns, and costs. Overall, both treatments can successfully restore oral function but root canals may involve fewer complications and costs compared to implants. The decision requires weighing risks and benefits based on the individual clinical situation.

1. ROOT CANAL
TREATMENT V/S
IMPLANT
DR MANJUSHA GOVIND
IIIrd YEAR PG

2. INTRODUCTION
OBJECTIVES OF ENDODONTIC TREATMENT
IMPLANTS-INDICATIONS AND CONTRAINDICATIONS
POTENTIAL RISKS OF OPTING FOR A ROOT CANAL OVER EXTRACTION AND IMPLANT
POTENTIAL RISKS OF OPTING FOR AN IMPLANT
DECISION MAKING: IMPLANT OR ROOT CANAL TREATMENT
FACTORS INFLUENCING TREATMENT PLANNING
 SURVIVAL RATES
 PATIENT FACTORS
 DURATION OF TREATMENT
 ESTHETIC CONCERNS
 FINANCIAL STATUS
 CLINICIAN’S PROFICIENCY AND PREFERENCE
 RISK FACTORS AND/OR COMPLEXITY OF EACH TREATMENT MODALITY
CONTENTS

3.  DENTAL IMPLANTS VS. ROOT CANAL TREATMENT - SUCCESS RATES.
 OTHER FACTORS NEED TO BE CONSIDERED
 CONCLUSION
 REFERENCES

4. Introduction
 One of the goals of a successful traditional dental practice has been the preservation
and rehabilitation of a patient’s natural dentition
 Endodontic treatment has played a key role in the retention and restoration of teeth
affected by pulp and/or periapical pathosis.
 Currently, the extraction of natural teeth has generally been considered undesirable
and as a treatment choice of last resort when there are financial considerations and
limited restorative options
 Clinicians frequently face the dilemma of whether to endodontically treat and retain a
questionable tooth or to extract and potentially replace it with a dental implant.
John et al., 2007; Morris et al., 2009

5. • Relief of pain = symptom free
•To render the affected tooth biologically acceptable and functioning without a
diagnosable pathosis
• Removal of pulp from root(s) of tooth
• Disinfections of root and surrounding bone
• Root canal treatment is an attempt to retain a tooth which may otherwise require
extraction
OBJECTIVESOF ENDODONTICTREATMENT

6. INDICATIONS :
 For partially edentulous arches
 For single tooth replacement where fixed partial dentures cannot be placed .
Patients who are unable to wear RPD.
 Patients desire .
 Patients who have adequate bone for the placement of implants.
CONTRAINDICATION
 Presence of non treated or unsuccessfully treated periodontal disease
 Poor oral hygiene.
 Uncontrolled diabetes.
 Chronic steroid therapy .
 High dose irradiation.
 Smoking and alcohol abuse.
IMPLANTS

8.  THE TREATMENT IS LESS INVASIVE
 ROOT CANAL MAY BE LESS EXPENSIVE
 RECOVERY PERIOD IS SHORTER
 MAINTAIN YOUR ORIGINAL TOOTH
 PROCESS IS NEARLY PAINLESS
 AESTHETICS ARE STILL GREAT
 TOOTH WILL FUNCTION WELL
 IMPLANT WILL USUALLY LAST A LONG TIME
Benefits of a Dental Implant
Benefits of a RCT
Potential risks of opting for a root canal over
extraction and implant
 A root canal might weaken the tooth
 The tooth may fail
 Complications Can Lead to Tooth Loss
Potential risks of opting for An implant
 Treatment Process Is More Invasive and Lengthy
 Longer Recovery Period
Root Canal vs Implant: Which Is Best? by Fermelia Dental | Jan 13, 2020

9. The main aim of both implant and endodontic therapies is to allow rehabilitation of the patient’s masticatory system
DECISION MAKING: IMPLANT OR ROOT CANAL TREATMENT

10. There are different schools of thought on retention of natural tooth with endodontic treatment and
conventional prosthodontic rehabilitation or to extract and replace it with an implant-retained prosthesis.
The argument favoring endodontic treatment relies on advances in the following factors:
• Advances in instrumentation and materials
• Greater predictability
• Cost-efficient compared to implants
• More conservative and less invasive
• Success rate is more compared to implants

11. In contrast, arguments favoring the implant placement focus on the following:
• The poor outcomes of endodontic treatment when compared to implant “success” rates of over
90%
• Concerns over the structural durability of a weakened endodontically treated tooth to support a
coronal restoration
• An implant fixture is seen as a better foundation for restorative dentistry than an endodontically
treated tooth
•
Implant or root canal treatment: Clinical guidelines and decision making K Pradeep, H Rajesh1 , Prassanna Kumar Rao2 , Shashi Kanth
Hedge3 , Harish Kumar Shetty

12. Factors influencing treatment planning
 Survival rates
 Patient factors
 Duration of treatment
 Esthetic concerns
 Financial status
 Clinician’s proficiency and preference
 Risk factors and/or complexity of each treatment modality
An Important Dilemma in Treatment Planning: Implant or Endodontic Therapy?
Funda Kont Cobankara and Sema Belli
October 21st, 2010Reviewed: March 17th, 2011Published: August 29th, 201

13. SURVIVAL RATES
 Survival rates of endodontic treatment and implant placement are generally taken into
account while choosing whether to extract or retain a compromised tooth.
 One of the primary reasons for the variability of reported outcomes is the inconsistent definition of
success in the evaluation criteria.
 Success in endodontics is very different from success for implants. The endodontic studies have
applied strict definitions of success based on clinical and/or radiographic criteria (i.e., absence of apical
radiolucency, looseness, and reduction in size of radiolucency) (Ng et al., 2007)
 while implant studies have considered an implant to be successful if it is functional and present in the
mouth without definite signs of absolute failure, such as peri-implant radiolucency or implant mobility
(Doyle et al., 2006)

14.  Implant studies generally report procedures completed by specialists,
while many endodontic studies involve work performed by students or
general dentist (Cheung, 2002; Salehrabi & Rotstein 2004; Alley et al.,
2004; White et al., 2006; Cohn, 2005; Trope, 2005).
 The average survival rate of teeth that are endodontically treated by a
general dentist is ~89.7% after 5 years; if the treatment is performed by a
specialist, the survival rate increases to 98.1% (Alley et al., 2004)

15. PATIENT FACTORS
 when designing a dental treatment plan, a patient’s expectations may bear
more important than the clinical factors.
 If an extraction is indicated for a tooth after the initial clinical examination,
but the patient wants to save it, the decision can be made to save the tooth;
however, the patient should be informed about the possible consequences
and potential risks associated with this decision (Avila et al., 2009).
 Other factors that should be considered include the dental history, the cultural
implications of the tooth loss, and the quality of life that such treatment would
produce (Bader, 2001, 2002; Tang & Naylor, 2005; Torabinejad & Goodacre,
2006; White et al., 2006; Cohn, 2005; Christensen, 2006)

16. • PATIENT’S AGE : In young people, implants are contraindicated until the growth
phase is completed because the fixture will ankylose, resulting in infraocclusion
• However, endodontic treatment can be applied to patients in every age group
• the patient’s health condition is also an important factor when deciding between
implant and endodontic therapy

17.  Diabetes mellitus is often accompanied with systemic adverse sequelae, such as
wound healing alterations, which may affect the osseointegration of dental
implants or healing of periapical lesions.
 In one study, patients with diabetes showed a reduced likelihood of endodontic
success, especially in cases with preoperative periradicular lesions (Fouad &
Burleson, 2003)

18.  Parafunctional habits of patients (such as bruxism) should also be
addressed when choosing the appropriate treatment for patients
(Cohn, 2005; Christensen, 2006).
 Because implants lack a periodontal ligament, they are at risk of
damage from extreme mechanical forces developed as a result of
parafunctional habits

19. DURATION OF TREATMENT
When the time for completion of treatment was evaluated
as the time from the beginning of the treatment until time
to function, implant treatment had a longer time-to-
function than endodontic therapy (Doyle et al., 2006).

20. ESTHETIC CONCERNS
 When the potential for esthetic acceptability appears to be questionable with
the planned implants and restorative therapy or especially in instances where
the esthetic outcome is extremely important for the patient, retention of the
affected tooth may be a better choice
 It has been stated that esthetic failures in implant dentistry are known to
outnumber mechanical failures, especially in the anterior dentition
Endodontics or implants? A review of decisive riteria and guidelines for single tooth
restorations and full arch reconstructions N. U. Zitzmann, G. Krastl, H. Hecker, C. Walter
& R. Weiger 2009

21. FINANCIAL STATUS
The financial factor may influence the decision-making process for both
clinicians and patients.
An implant-supported crown costs about twice that of an endodontically
treated tooth restored with a crown.
From an economic standpoint, endodontic treatment might be a more
favorable treatment option than implant-supported crowns

22. CLINICIAN’S PROFICIENCY AND PREFERENCE
The decision to restore a diseased tooth with endodontic treatment or
to extract the tooth and replace it with implant restoration might be
influenced by the clinician’s proficiency and clinical background
If a clinician believes that he/she is unable to save a tooth, tooth
extraction and future prosthetic replacement will most likely be
recommended

23. RISK FACTORS AND/OR COMPLEXITY OF EACH TREATMENT MODALITY
Treatment of a compromised tooth requires the consideration of
prosthodontic factors such as the extent of caries, crown-root ratio,
and dentinal wall thickness
endodontic factors including root canal anatomy, periapical pathology,
cause of primary failure in cases of retreatment, and the presence of
root resorption or root fracture
periodontal factors such as mobility and furcation problems

24.  If the longevity of a conserved tooth as related to these factors is
questionable, the extraction of the tooth may sometimes be a better
alternative than leaving the tooth in the mouth.
 The type of restorations used for endodontically treated teeth and the
quality of the coronal seal may have a greater impact on the long-term
retention of treated teeth than the endodontic treatment itself

25.  It should be considered that endodontically treated teeth are
associated with less complications and procedural interventions than
implant-supported crowns and that complications associated with
implant failure significantly impact a patient more negatively than
when endodontically treated teeth fail (Morris et al., 2009).
 While making a decision as to whether to retain and restore or to
replace a tooth, the restorative prognosis of the tooth and the physical
loading characteristics that it will be endured must also be kept in
mind.

26. Success criteria for root canal treated (RCT) teeth and implants.
Endodontics or implants? A review of decisive riteria and guidelines for single tooth
restorations and full arch reconstructions N. U. Zitzmann, G. Krastl, H. Hecker, C. Walter
& R. Weiger 2009
SUCCESS CRITERIA FOR ROOT CANAL TREATED (RCT) TEETH AND IMPLAN

27. Dental implants vs. root canal treatment - Success rates.
 Proving which of these two options is best is somewhat difficult. After all, if one
treatment has been performed, it's impossible to know what the outcome of the other
would have been.
 However, when the success rate of each alternative is considered independently, it's
easier to come up with an answer. And, in general, dental research has shown
that both treatment approaches can make an excellent choice.

28. What does dental research show?
Endosseous implants versus non-surgical root canal therapy: A systematic review
of the literature." (Blicher 2018)
This paper reviewed published research studies that either ...
 Evaluated the survival rate of teeth that had received root canal treatment.
 Or evaluated the success or failure of dental implant placement.
Its findings were ...
 The success rate for root canal treatment ranged between 92 and 97% (over a
time frame of four to eight years)
 The success rate for dental implants ranged between 95 and 99% (over a time
frame of two to six years).
These results suggest that the overall success rate of either treatment approach is
fairly similar

29.  what are the differences in outcomes of restored endodontically treated
teeth compared to implant-supported restorations?" (Iqbal 2017)
 This study, which was also a literature review, took into consideration 55 research
papers evaluating dental implants and 13 root canal treatment. It came to the
conclusion that no significant differences in survival rates existed between the two
approaches.
 It continued by stating that the decision for implant placement or root canal therapy
(including the placement of an appropriate dental restoration afterward) needs to be
based on factors other than just the statistical analysis of predicted treatment
outcome.
 In combination, the findings of both the Blicher and Iqbal literature reviews suggest
that both treatment options can provide a successful outcome.
Iqbal M, Kim S. What are the differences in outcomes of restored endodontically treated teeth compared to implant-supported
restorations. Int J Oral Maxillofac Implants. 2017;22(Suppl):96-116.

30. If the success rates are similar, what other factors need to be considered?
The fact that either root canal treatment or the placement of a dental implant
can be expected to provide an excellent end result suggests that the decision
between the two will need to hinge on other factors.
These include:
 Case selection. (How closely the patient's pre-treatment situation conforms to
the ideal
 Issues associated with specific patient characteristics, habits or concerns.
 Overall treatment cost or expected cost-effectiveness. This is an important factor because
completing full treatment is a necessary part of insuring a procedure's expected success
(especially root canal).

31. DIABETES
Diabetic patients in both endodontic and implant group
had more failure when compared with non diabetic
patients
SOCIOECONOMIC STATUS
Patients from higher socioeconomic group received
implant therapy (>2.4 times)than from lower SES group
AGE
Older patients- higher risk of Implant and RCT failures
REGION OF INTEREST
Patients who had done implant in maxillary and
mandibular posterior tooth had more failures than RCT
done in same location. SMOKING
Smokers in endodontic group have less failure than
implant group .Similarly in endodontic and implant groups
smokers had more failure than non smokers .

32. AUTHOR YEAR SAMPLE FACTOR
DISCUSSED
INFERENCE
Reese Ryan et
al
2015 n= 4084
RCT-3442
IMPLANT-642
AGE Treatment preferred by patient aged
19-46 years –RCT
>47 years - IMPLANT
Reese Ryan
et al
2015 n= 4084
RCT-3442
IMPLANT-642
SOCIOECONOMIC
STATUS
Treatment preferred by patient
High socioeconomic status-IMPLANT
Low socioeconomic status -RCT
Doyle scott et
al
2006 RCT –196
IMPLANT-196
REGION OF
INTEREST
Outcome based on region of interest
RCT – Not dependent on tooth location
IMPLANT placed in posterior tooth had more
failure
Doyle scott et
al
2007 RCT –196
IMPLANT-196
SMOKING Treatment outcome in smokers
RCT – Less failure (19.2%)
IMPLANT- More failure (27.1%)

33. Are there more complications in implants? (Doyle, et al., 2016), reported that dental implants had
a 5 x greater number of complications compared to restored RCT teeth.
Do outcome assessments reflect technology in evolution? Evidence that with new technology,
advancement in electronic apex locators, operating microscopes & materials such as therma-
fill,gutta-percha core and MTA, these all have improved the safety and accuracy of RCT. (Toskos
& DiBernardo, 2013)
If apical periodontitis persists or develops after root canal treatment then what treatment
procedure should be recommended? Reported radiographic success rates of studies with modern
microscopic surgical endodontic procedures often are greater than 90%. (Stoumza, 2015)

34. Is RCT preferred in patients with poor quality of bone?
Quality of bone is an important consideration when treatment planning for implants (Mombelli
& Cionca, 2016).
(Christensen, 2016), advised that if bone density/area is problematic or there are anatomical
structures present, then RCT should be considered.

36. Bone healing around modern implants follows established sequence of
events and results in predictable osseointegration.
In a healing bone wound, fibroblast-like osteogenic progenitor cells
differentiate into osteoblasts and start to deposit woven bone that
gradually grows towards the implant surface.
Wound healing around dental implants
Cristina C. Villar,Guy Huynh-Ba,Michael P. Mills,David L. Cochran
Wound healing around dental implants
 During 1–3 months of healing, this woven bone
is replaced by lamellar bone with increasing bone
to implant contact that allows functional loading
of the implant.

37. As a clinical application, implant stability is initially decreased up
to three weeks due to bone remodeling and followed by an
increase to the baseline at 4–5 weeks and then reaching
plateau in 8 weeks.
 Regardless of this remodeling, studies have shown that
implants can be successfully loaded immediately after
placement although with somewhat reduced survival rates.
 Development of new implant surfaces has played a critical role
in expanding these clinical loading protocols.

38. Conclusion
 Patient’s preference is of fundamental importance. Some patients prefer not to
have extractions at all costs while others avoid high-risk treatments and prefer
low risk options.
 It is the dentists responsibility to involve them in treatment planning by
explaining the prognosis of keeping the tooth, costs of treatment and other
treatment options to the patients from a professional point of view

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 Das. Concise textbook of surgery. 3rd ed. Calcutta, Dr.S.Das publishers; 2002: 1-7.
Newman MG,Takei HH, Klokkevold PR, Carranza FA. Clinical Periodontology. 10th ed.
Missouri: Saunders; 2009: 912, 914-915, 935-936, 960, 1010-1011.
 Journal of Burns andWounds (http:/ / www. ncbi. nlm. nih. gov/ pmc/ journals/ 211/ )
 Villar CC, Huynh‐Ba G, Mills MP, Cochran DL. Wound healing around dental implants.
Endodontic Topics. 2011 Sep;25(1):44-62.
 Ricucci D, Lin LM, Spångberg LS. Wound healing of apical tissues after root canal therapy: a
long-term clinical, radiographic, and histopathologic observation study. Oral Surgery, Oral
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41. THANK YOU