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I 07 roots 1_2016 C.E. article_ treatment planning I ArecentsystematicreviewpublishedintheJour- nal of the American Dental Association highlights a key question: “Is the long-term survival rate of dentalimplantscomparabletothatofperiodontally compromised natural teeth that are adequately treated and maintained?”8 Nineteen studies with a follow-up period of at least 15 years were included in the analysis. The results show that implant survival rates do not exceed those of compromised but ad- equately treated and maintained teeth. These findings support other studies comparing long- term survival of implants and natural teeth,9,10 providing an important message: Periodontally compromised teeth can be retained with quality treatment and appropriate maintenance. There- fore, it may be advisable to postpone implant consideration for the periodontitis-susceptible patient to fully utilize and extend the capacity of the natural dentition.11 _Treatment planning options A key focus of the Joint Symposium involved treatment planning decisions regarding endo- dontic treatment and implant therapy. Should a tooth with pulpal disease be retained with root canal treatment and restoration, or be extracted and replaced with an implant-supported resto- ration? This assessment involves a challenging and complex decision-making process that must be customized to suit the patient’s needs and desires.12-14 The topic has received considerable attention in the literature, the media and at dental continuing education courses. Endodontic treatment and implant therapy should not be viewed as competing alternatives, rather as complementary treatment options for the appropriate patient situation (Figs. 1a, b). Root canal treatment is indicated for restorable, periodontally sound teeth with pulpal and/or apical pathosis. Endodontic treatment on teeth with nonrestorable crowns or teeth with severe periodontal conditions iscontraindicated,andotheroptionssuchasimplant placement should be considered.15 When making treatment decisions, the clinician should consider factors including outcome assess- ment, local and systemic case-specific issues, costs, the patient’s desires and needs, esthetics, potential adverse outcomes and ethical factors.16 _Outcome assessment: Success and survival Treatmentoutcomesplayakeyroleintheassess- ment of different treatment options. Patients often ask whether a procedure is going to be successful or not. This question can be challenging for a clinician toanswerduetothevarietyofreportedoutcomesin the literature.17 There are differences in the method- ology and criteria used to evaluate the outcomes for root canal treatment and implant prosthetics, which makes comparisons between success rates difficult, if not impossible.18 Endodontic studies have historically used “suc- cess” and “failure” as outcome measures and have focused on a strict combination of radiographic and clinical criteria.19 In contrast, the implant literature has primarily reported “survival,”20, 21 i.e., the implant iseitherpresentorabsent.Therefore,implantstudies that solely evaluate survival as an outcome measure will likely publish higher success rates than endo- dontic studies that rely on biologic healing and fac- tors related to the entire restored tooth. To establish more valid and less biased comparisons, the same outcome measures should be used. A more patient- centered measure is to compare the outcome of survival, which is considered to be an asymptomatic tooth/implant that is present and functioning in the patient’s mouth.22,23 Multiple large-scale studies including millions of teeth have used survival to assess the outcome fol- lowing root canal treatment. An investigation using an insurance database of more than 1.4 million root canal-treated teeth demonstrated that 97 percent were retained within an eight-year follow-up pe- riod.24 Otherstudiesshowsimilarlyhighsurvivalrates Fig. 2a_Pre-op image of tooth #29. Note lateral radiolucency and complex canal anatomy. Fig. 2b_Two-year recall image reveals both excellent endodontic and restorative treatment. Note healing of lateral radiolucency. Courtesy of Dr. Joe Petrino. ENDODONTICS: Colleagues for Excellence Outcome Assessment: Success and Survival Treatment outcomes play a key role in the assessment of different treatment options.Patients often ask wheth is going to be successful or not. This question can be challenging for a clinician to answer due to the varie outcomes in the literature (17). There are differences in the methodology and criteria used to evaluate the root canal treatment and implant prosthetics, which makes comparisons between success rates difficult, if n (18). Endodontic studies have historically used “success” and “failure” as outcome measures and have focu combination of radiographic and clinical criteria (19). In contrast, the implant literature has primarily repo (20, 21), i.e., the implant is either present or absent. Therefore, implant studies that solely evaluate survival measure will likely publish higher success rates than endodontic studies that rely on biologic healing and fac the entire restored tooth.To establish more valid and less biased comparisons, the same outcome measures s A more patient-centered measure is to compare the outcome of survival, which is considered to be an asymp implant that is present and functioning in the patient’s mouth (22, 23). Multiple large-scale studies including millions of teeth have used survival to assess the outcome follow treatment. An investigation using an insurance database of more than 1.4 million root canal-treated teeth that 97 percent were retained within an eight-year follow-up period (24). Other studies show similarly high (25, 26) (Table 1).An epidemiological approach allows for the assessment of tooth retention from a large sam experiencing actual car practices. Systematic and controlled studies f settings complement findings. Two prospectiv reported 95 percent surviv years (28) and four to six teeth after initial root can PredictableTooth Retention: Nonsurgical Root CanalTreatment and Restoration Authors Number of Teeth Follow-up (years) Survival (percent) Salehrabi and Rotstein (24) 1,463,936 8 97 Chen et al. (25) 1,557,547 5 93 Lazarski et al. (26) 44,613 3.5 94.4 Table 1. Survival rates following initial nonsurgical root canal treatment Fig. 2a Fig. 2b Table 1_Survival rates following initial nonsurgical root canal treatment. (Table/Provided by American Association of Endodontists) Salehrabi and Rotstein (24) 1,463,936897 Chen et al. (25) 1,557,547593 Lazarski et al. (26) 44,6133.594.4