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roots - international magazine of endodontology No. 3, 2016

| CE article treatment planning 08 roots 3 2016 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 (Table 1).25, 26 An epidemiological approach allows for the assessment of tooth retention from a large sam- ple of patients experiencing actual care in private practices.Systematicreviews27 andcontrolledstudies from academic settings complement the previous findings.Twoprospectivetrialseachreported95per- cent 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 Themajorityofendodontictreatmentisperformed bygeneraldentistswithahighdegreeofsuccess.26 For complex cases, referral to an endodontist with addi- tional training and expertise may result in more fa- vourableoutcomes30 andpositivepatientexperiences.31 Interdisciplinary care is important for the manage- ment of endodontically treated teeth. The restorative dentistplaysasignificantroleintheoutcomebypro- viding an appropriate and timely restoration.32 Root canaltreatmentisnotcompleteuntilthetoothiscor- onallysealedandrestoredtofunction.Multiplestud- ies have confirmed that a definitive restoration has a significant impact on survival,24, 25, 27, 28, 33 Therefore, the likelihood of a favorable outcome increases with both skillful endodontic care and prompt restorative treatment (Figs. 2a & b).34 Advancements in technology aid in attaining high levels of tooth retention. The dental operating micro- scope,nickel-titaniuminstruments,apexlocators,en- hanced irrigation protocols and dentin preservation strategies are examples of improvements that allow clinicians to predictably manage a greater range of treatment options. Additionally, cone beam-com- puted tomography facilitates more accurate diagno- sis and improved decision-making for the manage- ment of endodontic problems.35, 36 Comparative studies: Endodontically treated teeth and single-tooth implants Large-scalesystematicreviewshaveaddressedthe relativesurvivalratesofendodonticallytreatedteeth and single-tooth implants. The Academy of Osseo­ integrationconductedameta-analysisusing13stud- ies (approximately 23,000 teeth) on restored end- odonticallytreatedteethand57studies(approximately 12,000 implants) on single-tooth implants. The out- come data demonstrated no difference between the two groups during any of the observation periods.37 Another systematic review supported by the Ameri- can Dental Association compared the outcomes of endodontically treated teeth with those of a single-­ 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) 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.2a Fig.2b Fig.3 32016

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