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roots - international magazine of endodontology No. 3, 2016

| CE article treatment planning 10 roots 3 2016 A benefit of root canal treatment is the short time frame required to completely restore both dental functionandaesthetics.Inonestudyofabout400pa- tients, the restored single-tooth implant showed a longer average and median time to function than similarlyrestoredendodonticallytreatedteeth.Addi- tionally, the implant group had a higher incidence of post-treatment complications requiring subsequent treatment interventions.39 This increased post-oper- ative care can impact patients in terms of additional visits, lost wages and unforeseen costs. Clinicians should consider the patient’s prefer- ences, which are often related to function, comfort and aesthetics. Tooth loss is associated with an im- paired quality of life,54 and surveyed patients express acleardesiretosavetheirnaturaldentitionwhenever possible.2 Large-scalesurveysofpost-endodonticpa- tientshavedemonstratedthatendodontictreatment not only preserves the natural tooth, but also signifi- cantly improves patients’ quality of life.55 More than 97percentofpatientsreportbeingsatisfiedwiththeir endodontic treatment.31 If an implant is used to re- store an edentulous space, a similarly high percent- age of patients have a positive experience with im- plant therapy.56 Furthermore, comparative studies demonstrate that patients report a high degree of satisfaction with the overall experience following both procedures.2, 15 Despite high survival rates, both endodontically treated teeth and implants are susceptible to com- plications. Non-restorable caries, prosthetic failures, periodontal disease, crown/root fractures and spe- cific endodontic factors are examples of complica- tionsfollowingrootcanaltreatment.57 Complications associated with implants and related prostheses in- clude: surgical, implant loss, bone loss, peri-implant soft-tissue, mechanical and aesthetic/phonetic.58 A retrospective study directly compared the rates of additional interventions related to complications. Implantcaseshadasubstantiallyhigherneedforsub- sequent intervention and maintenance visits than endodontically treated teeth.40 However, a more re- cent prospective study suggests that patients from bothgroupshaveminimalcomplicationsatone-year follow-up.15 Endodontic retreatment options Theconsequencesoffailureandsubsequenttreat- mentdifferbetweenendodonticsandimplants.End- odontic failure can usually be addressed successfully by retreatment, microsurgery, or by extraction and potential implant placement. Intervention after im- plant failure may vary from minimal restorative re- pairs to multiple corrective surgeries and/or the use of a different prosthesis.59 Nonsurgical retreatment, or revision, is often the first choice to address post-treatment apical peri- odontitis,60, 61 provided that the tooth is suitable for further restoration and that the restoration will have a good long-term prognosis (Figs. 4a & b).62 Current bestevidenceindicatesthatthesurvivalofnonsurgi- cal retreatment is similar to that of primary treat- ment,andthatthetwotreatmentssharesimilarprog- nostic factors.63 Two studies specifically evaluated survival following retreatment. An epidemiological studyusinganinsurancedatabaseof4,744retreated Fig.5a: Pre-op image of tooth #19 with pulp necrosis and chronic apical abscess. Fig.5b:Two-year recall image demon- strates excellent endodontic treatment and healing of apical periodontitis. (Courtesy of Dr Deb Knaup) Fig.6a: Pre-op image.Tooth #14 was determined to have a vertical root fracture of the MB root.The patient expressed a strong desire to retain the natural dentition but also to rehabilitate the edentulous space. Fig.6b:Two-year recall image.Tooth #14 had retreatment and resective surgery on the MB root.Two dental implants have restored the edentulous space.(Courtesy of Dr.Brian Barsness and the University of Minnesota School of Dentistry) Fig.5a Fig.6a Fig.6b Fig.5b 32016

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