Comparison Of Long-term Survival Of Implants And Endodontically Treated Teeth

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Comparison Of Long-term Survival Of Implants And Endodontically Treated Teeth
Comparison Of Long-term Survival Of Implants And Endodontically Treated Teeth

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Video: Что лучше? Зуб или имплантат(имплант)? (часть2) 2022, November
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The main goal of dentistry is to help people maintain their dentition. There is now a trend towards a simplified "removal and implant" approach, but this is not always simpler and ethical.

Comparison of long-term survival of implants and endodontically treated teeth
Comparison of long-term survival of implants and endodontically treated teeth

Endodontics includes primary and secondary treatment as well as periapical surgery. The purpose of these manipulations is to preserve the tooth with subsequent restoration. Dental implants replace missing teeth or those that cannot be preserved. But teeth should not be prematurely extracted, as the goal of dentistry is the long-term health of the patient. Endodontics and implantation should complement each other, not compete.

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Benefits of implantation

Implantation is one of the greatest advances in dentistry, but can they solve all clinical situations? In case of end defects, it is much better to install implants than to make removable dentures. If one tooth is missing, different treatment options are possible: adhesive restoration, extractions without replacement, bridge or implant. Today, bridges are used less and less because they require preparation of adjacent teeth, disrupting their structure. Also, the survival rate of such constructions is lower than that of a single implant. Therefore, implantation has advantages that could not have been imagined in the past.

The price for a turnkey dental implantation essentially depends on the cost of a dental implant, the type of prosthesis, as well as on the number of teeth to be restored.

Survival versus success in implantation and endodontics

Modern dentistry must follow evidence-based medicine. Therefore, it is necessary to compare the survival rate and success of each of the manipulations. The term survival is almost never used in endodontics. And when in endodontics the criteria for success are quite accurate: resolution of apical periodontitis and the absence of symptoms, then in implantation they are more blurred. In implantation, it is worth distinguishing between survival and success, since in the first case it is only a lack of mobility. Albrexton believes that success is implant immobility, lack of radiological confirmation of peri-implantitis, bone loss near the implant of less than 2 mm per year after implantation, as well as permanent or irreversible symptoms such as pain, infection, neuropathy, paresthesia, or any intervention in the mandibular channel.

For 7 years, the overall survival rate of 1022 implants became 92.9%, while the success rate was only 83.4% (Brocard et al., 2000). Depending on the prosthetic design, the survival / success results will be as follows:

• single implant 95.6% / 75.6%;

• cantilever prosthesis - 94.4% / 76.3%;

• partial bridges - 96.1% / 73.8%;

• full bridges 100% / 63, 8%;

• dentures with support on a tooth and an implant 90.6% / 70.6%;

• covering prostheses - 95.7% / 78.6% (Romej et al., 2004).

Based on health insurance data, 1,462,936 primary endodontically treated teeth were observed over 8 years. (Salehrabi and Rotstein, 2004). Of these, 97% were retained, and only 3% required secondary endodontics, surgical treatment, or were removed. In a meta-analysis, there was no significant difference in survival at 6 years between single implants (95%) and endodontically treated teeth (94%) (Iqbal and Kim, 2007).

Old and new techniques in endodontics and implantation

Endodontics of the XXI century adores many new tools and devices, previously unknown and gradually demonstrated since the 90s. Many of the studies included in the meta-analyzes used techniques that are old and irrelevant today. A recent randomized study comparing the success rate of apical periodontitis treatment at one and two visits reported an average success rate of 92.9% over 2 years according to the PAI.The key to success to these results may be the use of a microscope, biologically adequate instrumental expansion, irrigation and its activation, rotary nickel-titanium instruments, ultrasound preparation, improved disinfection protocols and, more recently, cone beam computed tomography.

It would be a mistake to include data from 5 or 6 decades ago in modern studies, as they may have been carried out before the advent of ISO standards, irrigation with sodium hypochlorite, use of calcium, and they used old methods of obturation such as silver monopod, resorcinol-formalin and other techniques. … This can be compared to implantation with disc implants or other types that have taken root through fibrous integration. Therefore, attention should be focused on modern advances and methods in any field.

Implants with SLA, RDM and other types of rough surfaces are considered to be a significant improvement in implantation. Nevertheless, technically, these are the same implants that take root through osseointegration, but their survival rate is much higher, from 97% to 98% (Kotsovillis et al., 2009). An increase in roughness can facilitate biofilm formation (Subramani et al., 2009), which in turn contributes to the development of peri-implantitis (Wennstrom et al., 2004). Due to the successful results of osseointegration, the focus of implantation has shifted from the overall success of the implantation to the change in the level of the marginal bone. When using modern systems, it ranges from 0.24 (± 0.10) mm to 0.75 (± 0.05) mm.

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Conclusion

Market strategies and economic forces have led to the continuous commercialization of clinical practice. If dental education becomes dominant for companies rather than educators and experienced doctors, or if fewer patients are treated by specialists, we should not be surprised when the number of implants and / or endodontic complications or failures increases. The survival rate for implants placed by inexperienced practitioners was 73.0% compared with 95.5% after treatment by implantation specialists (Morris and Ochi, 2000a, b). Comparison of dental survival rates after endodontic treatment by endodontic specialists versus general practitioners in a multicenter study of 350 teeth that met the inclusion criteria showed a difference of only 98.1% versus 89.7% (Alley et al., 2004).

Both: Implants and endodontically treated teeth show significant results when the treatment is correctly selected and performed. However, the extracted tooth disappears irreversibly, so it should be removed only after careful consideration. There is no lifetime warranty for an endodontically treated tooth or an implant. Both options should be seen as complementary, not competing, and such that they should serve a common purpose in dentistry - long-term health and patient benefit, while being the least invasive and restorative in function and aesthetics. To achieve these goals, it is important that clinicians are fully aware of the true long-term results of both implants and endodontically treated teeth.

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