Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions

This review describes practical criteria and a systematic process to aid the treatment planning decision of whether to preserve teeth by root canal treatment (RCT) or extract and provide an implant. Recommendations presented are based on best available evidence from the literature and the expert views of specialists in endodontics and restorative dentistry, including dental implantology. A MEDLINE search was conducted using the terms 'root canal therapy', 'dental implants', 'decision making', 'treatment planning', 'outcome' and 'human', and supplemented by hand-searching. When evaluating the outcome of root canal treatment, an observation period of 4-5 years is required for complete healing of periapical lesions. Dental implants, however, present a de novo situation and a functional period of at least 5 years is often required before peri-implant diseases are established and detected. Good long-term success rates and greater flexibility in clinical management indicate that RCT or retreatment should be performed first in most instances unless the tooth is judged to be unrestorable. When deciding if a compromised tooth of questionable prognosis should be maintained or replaced by an implant, both local, site-specific and more general patient-related factors should be considered. Following systematic evaluation and consideration of the best treatment option in a particular case, a treatment recommendation may then be given in favour or against tooth retention. Whilst single risks are possibly accepted for single tooth restorations, teeth with questionable prognosis and multiple pre-treatment requirements are better not included as abutments in fixed dental prostheses to reduce the risk to survival of the entire restoration.