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Table of Contents

1. Introduction 03

2. History

2.1. History of Endodontics 05

2.2. History of Implantology 10

2.3. Methods in Endodontics and implantology therapy 13

2.3.1. Endodontic Microsurgery to Save Teeth 15

2.3.2. Same day (Immediate) load implantation 17

3. Factors influence the treatment plan

3.1. Survival rates 19

3.2. Patient factors 24

3.3. Treatment duration 27

3.4. Esthetics concerns 29

3.5. Treatment Cost 31

3.6. Risk factors 33

4. Conclusion

5. Acknowledgment

6. References

1. Introduction

Dentists frequently face the predicament of whether to endodontically treat a dubious tooth

or to replace it with an implant. Dentists make the decision for extracting a tooth based on

risk factors such as periodontal and endodontic criteria, remaining tooth structure, size of

previous restorations and the strategic level of a tooth within the dentition. A single

recognizable risk can be easy to manage clinically, but presence of multiple risk factors

endanger the survival of a compromised tooth.[114][156]

Literary data are the foundation for the risk evaluation and long-term prognosis

determination of the tooth requiring root canal treatment (RCT) or extraction and

replacement with an dental implant. The literature, contains contradiction in terms of the

meaning of success and survival of endodontically treated teeth and implants.[70]

Likewise, the reported success rates do not equate to the likelihood of a aid and abet

outcome when applied to a special case.[73]

Iqbal and Kim found that much more rigorous outcome criteria were applied to the

evaluation of ‘successful’ RCT, inclusive the lack of a periapical radiolucency. On the other

hand, the use of less rigorous criteria in dental implantology may interpret to higher rates

of success.[70]

In accordance with a review, the survival of healthful and treated teeth is greater than that

of implants, provided that dental implant loss before loading was added to that during

function over 10 years.[56]

Additional misunderstanding is provoked since, in some studies, retention or survival rates

including successful teeth and also implants classified as surviving. The reader in implant

studies must know the differences in outcome data based on the restoration or implant

level, which involves superstructures and Implants.[113]

3

In root canal treated teeth, complications are mainly connected to endodontic retreatment,

or obstinate apical periodontitis as evaluated from radiographs, whereas in implants,

different technical problems appears or surgical interventions were needed to treat periimplantitis.[

35]

In multiple publications discussion behaved on whether tooth conservation by surgical and

nonsurgical endodontic means, or replacement with an dental implant is more useful in the

long-term, i.e., whether ‘Implants are better than teeth’ or ‘Implants are more trustworthy

abutment’.[9] [27] [32] [41] [74] [95] [83] [121] [133] [140] [141] [144] [154]

Due to the alike outcomes of implant and RCT, the adjudication to replace a tooth with an

implant or treat it endodontically , should be on basis of factors different than expected

treatment result alone.[98]

The main aim of my thesis is to describe the crucial criteria & a systematic process for

deciding upon RCT or the implant, in basis of the best proof from the literature. Regarding

treatment considerations which lack clear evidence in basis of guidelines, a unity was

reached under the authors specialized in restorative and endodontics dentistry and

implantology.

4

2.1 History of Endodontics

Endodontics is a field of dentistry begined in 17th century and interested with the study of

Anatomy, Pathology, Physiology of the dental pulp & periradicular region and the way of

their treatment. Its study and practice embraces the basis of clinical sciences and biology

of the pulp including prevention and treatment of the injuries and diseases of the pulp, and

connected periradicular conditions.[7]

Charles Allen, was the mother of invention and writer of the first dentistry book in English-

Language and described the techniques of transplantation in dentistry. He experimented

new materials, instruments, and techniques, to relieve pain of teeth and maintain exposed

pulp in 1687.[28]

Pierre Fauchard was the founder of modern dentistry and writer of “Le chirurgien dentiste”

described the dental pulp and tooth worm, considered the cause of toothaches and caries

since the time of the Assyrians. He also demonstrated the removal of pulp tissue in 1746.

[94]

Leonard Koecker used heat instruments to singe exposed pulp and preserved it with lead

foil.[7]

Shearjashub Spooner introduced arsenic trioxide for pulp devitalization in 1836, and two

year after Edwin Maynard presented the first root canal instrument created by filing a

watch spring.[7]

„Gutta-percha“, a filling material was presented in 1847 by Edwin Truman.[7]

S.C. Barnum prepared for tooth isolation during filling a rubber leaf in 1864, and later in

1873 he introduced the first rubber dam clamp-forceps with G.A. Bowman.[4][29]

Bowman obturated in 1867, root canals using gutta-percha cones as the single material.

And Magitot used an electric current for testing pulp vitality