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08 I I C.E. article_ treatment planning (Table 1).25,26 An epidemiological approach allows for the assessment of tooth retention from a large sampleofpatientsexperiencingactualcareinprivate practices. Systematic reviews27 and controlled stud- iesfromacademicsettingscomplementtheprevious findings. Two prospective trials each reported 95 percent survival rates at four years28 and four to six years29 for teeth after initial root canal treatment. _Predictable tooth retention: Nonsurgical root canal treatment and restoration The majority of endodontic treatment is per- formed by general dentists with a high degree of success.26 For complex cases, referral to an endo- dontist with additional training and expertise may result in more favorable outcomes30 and positive patient experiences.31 Interdisciplinary care is im- portant for the management of endodontically treatedteeth.Therestorativedentistplaysasignifi- cant role in the outcome by providing an appropri- ate and timely restoration.32 Root canal treatment is not complete until the tooth is coronally sealed and restored to function. Multiple studies have confirmed that a definitive restoration has a sig- nificant impact on survival.24,25,27,28,33 Therefore, the likelihood of a favorable outcome increases with both skillful endodontic care and prompt restora- tive treatment (Figs. 2a, b).34 Advancements in technology aid in attaining high levels of tooth retention. The dental operat- ing microscope, nickel-titanium instruments, apex locators, enhanced irrigation protocols and dentin preservation strategies are examples of improve- ments that allow clinicians to predictably manage a greater range of treatment options. Additionally, cone-beam-computed tomography facilitates more accurate diagnosis and improved decision-making for the management of endodontic problems.35,36 _Comparative studies: Endodontically treated teeth and single-tooth implants Large-scale systematic reviews have addressed the relative survival rates of endodontically treated teeth and single-tooth implants. The Academy of Osseointegration conducted a meta-analysis using 13 studies (approximately 23,000 teeth) on re- stored endodontically treated teeth and 57 studies (approximately 12,000 implants) on single-tooth implants. The outcome data demonstrated no dif- ference between the two groups during any of the observation periods.37 Another systematic review supported by the American Dental Association compared the outcomes of endodontically treated teethwiththoseofasingle-toothimplant-restored crown, fixed partial denture and no treatment after extraction. At 97 percent, the long-term survival rate was essentially the same for implant and en- dodontic treatments. Both options were superior to extraction and replacement of the missing tooth with a fixed partial denture.38 Retrospective studies also have compared the outcomes for the two treatment options. A study conducted at the University of Minnesota compared theoutcomesof196restoredendodonticallytreated teeth with 196 matched single-tooth implants.39 Both groups had 94 percent survival rates. The survival curves for these two groups are provided in Figure 3. Another investigation from the University of Alabama provided similar results.40 Based upon similar survival rates, the decision to treatacompromisedtoothendodonticallyorreplace it with an implant must be based on factors other than treatment outcome.37,41 Several factors influ- ence the decision-making process.42-44 The following lists provide an overview of case-specific factors that should be considered in making this treatment decision. roots 1_2016 ENDODONTICS: Colleagues for Excellence 4 ated ssed the teeth and ntegration oximately teeth and gle-tooth difference servation ed by the outcomes a single- ture, and the long- r implant superior oth with a utcomes for the two treatment options.A study conducted at the University ored endodontically treated teeth with 196 matched single-tooth implants he survival curves for these two groups are provided in Figure 3.Another vided similar results (40). to treat a compromised tooth endodontically or replace it with an implant outcome (37, 41). Several factors influence the decision-making process f case-specific factors that should be considered in making this treatment antitis or implant failure is extensive. It includes systemic disease, genetic smoking, periodontal disease, radiation therapy, diabetes, osteoporosis, affect endodontic treatment outcomes.Risk factors that may be associated teeth include smoking (46),diabetes (28,46),systemic steroid therapy (28) tive (i.e., bisphosphonates) medications may have an increased risk for s of the jaw. This may affect treatment planning for both implant and ompletion of dental and skeletal growth prior to implant placement (48). storations; adequate ferrule comprehensive restorative plan ate biologic width on Fig. 3. A matched-case comparison of survival rates after treatment with either a restored endodontically treated tooth (n=196) or a restored single-tooth implant (n=196) performed at the same institution. J Endod 2006;31. Fig. 3 Fig. 5a Fig. 5b Fig. 4a Fig. 4b Fig. 3_A matched-case comparison of survival rates after treatment with either a restored endodontically treated tooth (n=196) or a restored single-tooth implant (n=196) performed at the same institution. J Endod 2006;31. Fig. 4a_Pre-op image of tooth #30 with previous endodontic treatment and persistent apical periodontitis. A dentist initially recommended extraction and replacement of this tooth with an implant. The patient requested a second opinion from an endodontist who determined the tooth to be treatable. Fig. 4b_Four-year recall image demonstrates apical healing following nonsurgical retreatment. Accurate diagnosis prevented the unnecessary treatment of tooth #31. Courtesy of Dr. Martin Rogers. Fig. 5a_Pre-op image of tooth #19 with pulp necrosis and chronic apical abscess. Fig. 5b_Two-year recall image demonstrates excellent endodontic treatment and healing of apical periodontitis. Courtesy of Dr. Deb Knaup.