Dear Ashok,

You've asked a classic question and this debate has been going on for years. Well, to answer now ... I think you can find 100s of papers favoring implant placement and on the other hand, many papers can be found which state that root canal therapy should be the treatment of choice.

Now I strongly believe that the choice will depend upon the scenario you are facing. There may be instances where implant placement is contraindicated because of medical or dental reasons and you may not have a choice. On the other hand, there may be instances where implant placement could be the choice. This will actually depend upon the prognosis of the tooth. This question is difficult to answer and treatment planning would again be the key here. You must do careful case selection in case you decide any of the treatment modality.

During my 15 years of clinical experience, I tend to convince the patient for an endo or a re-endo because I would want to preserve the natural dentition and the PDL (but then I do consider the prognosis too). If there is no hope then I would plan for implant placement.

I wish you all the best for your decisions.

Regards

Thank you sir for your analysis. let's hope everyone concerned understand the importance of saving the natural teeth.

Natural tooth is the best implant  that ever presented ,it is Durable even after Death for  million of years and this is evidence based fact knowledge .  Forensic science have had relay on this fact for centuries .

If we as dentist consider every patient as our  family and we consider ourselves as  above average dentist we will never let our patients even go near Root canal treatment attempt because as dentist our mission is to preserve  and prevent dental and gum diseases to save dentition by motivation and closed control.

You would agree I suppose  ,but this concept was available when Dentistry for long time was (Art and Science)  where we did long last restorations or when we achieved to control active periodontal disease  or save many teeth by Root canal treatment or even Re-Root canal treatment.

But now majority of  Dentists and manufacturers and insurance companies  had changes the concept of (art and science)  to  ( art of business in  Dentistry ) giving misleading solutions to unnecessary treatment solution like  implants ,what called (Hollywood smile)?????       

I agree with some of the reviewers say but just evaluating the prognosis of doing root canal therapy is not the total answer. You must evaluate the adjacent teeth to the one in question as well the remaining teeth in the arch you going to treat. The TOTAL picture is a must. Basically I have as most dentists have strive to save natural teeth as long as it is scientically correct............If saving a tooth with minimum amount of bone and patient does do much for him or herself in taking proper care of their remaining teeth then implants would certainly a better choice with a prognosis for. Many  more years t hen the natural tooth might have. Don,t just evaluate the tooth in question but a thorough full mouth evaluation .  Stan Markovits. 

Stanley Markovits responded as following;

"If saving a tooth with minimum amount of bone and patient does no much for him or herself in taking proper care of their remaining teeth then implants would certainly a better choice with a prognosis for."

If patient can not take care of his natural teeth, how one can expect from him to take care of the inserted implant. In such case, the implant will also fail as implant requires care taking no less than one's natural teeth.

I think debate on  "RCT versus implant" is a useless execise. It seems to be a "salesman's" mentality to compare these two choices which have been developed for ptient's benefit, not for operator's own welfare. Both of the options are avaialble to a operating dentist who should use them judiciously as per indication of the patient's clinical situation.

Stanley Markovits responded as following;

"If saving a tooth with minimum amount of bone and patient does no much for him or herself in taking proper care of their remaining teeth then implants would certainly a better choice with a prognosis for."

If patient can not take care of his natural teeth, how one can expect from him to take care of the inserted implant. In such case, the implant will also fail as implant requires care taking no less than one's natural teeth.

I think debate on  "RCT versus implant" is a useless execise. It seems to be a "salesman's" mentality to compare these two choices which have been developed for ptient's benefit, not for operator's own welfare. Both of the options are avaialble to a operating dentist who should use them judiciously as per indication of the patient's clinical situation.

Interesting and very relevant discussion Dr. Ashok.

See the January issue of the Journal of Dental Research 2016 - text below;

Journal of Dental Research jdr.sagepub.com doi: 10.1177/0022034515618942 JDR January 2016 vol. 95 no. 1 5-6 Are Dental Implants a Panacea or Should We Better Strive to Save Teeth? W.V. Giannobile1,2⇑ N.P. Lang3

Dental implants have become an important treatment for the replacement of teeth lost due to disease, injury, or congenital tooth agenesis (Adell et al. 1990). Over the past 30 years, the incorporation of dental implants into everyday clinical dental practice has resulted in major improvements in oral health of our patients through enhancements in function, esthetics, and phonetics. In this month’s issue of the Journal, we highlight new evidence on the biological complications of dental implants and the great challenges associated with predictable implant therapy. These adverse outcomes associated with implants have come to the forefront of discussion groups in periodontology, oral surgery, prosthodontics, and implant dentistry relating not only to prosthetic (technical) failure but also persistent infections surrounding implants. A recent systematic review based on a European consensus conference revealed that the prevalence of peri-implant mucositis and peri-implantitis ranges from 19% to 65% (Derks and Tomsai 2015). This month, results from one of the largest studies performed in Sweden show that peri-implantitis and peri-implant mucositis are common biological complications of implant therapy (Derks et al. 2016) that may jeopardize the longevity of reconstructions on implants. Tarnow (2016) comments on how far we have come in implant dentistry while at the same time recognizing the influence on success of implant placements by generalists, specialists, and different implant configurations/surfaces. One finds that reconstructive therapy of periimplantitis lesions is unpredictable as yet when compared to surgical resection, as evidenced by recent investigations and systematic reviews (Khoshkam et al. 2013; Carcuac et al. 2016; Jepsen et al. 2016). A trend affecting clinical practice over the past 2 decades has been the reduced emphasis to “save compromised teeth.” In fact, studies have demonstrated that those with less training in periodontology and implant dentistry generally apply reduced efforts in addressing tooth retention (Lang-Hua et al. 2014). It is noted that less trained individuals are often recommending tooth extraction versus retention. As such, many teeth are being condemned at early stages given the expediency that lends itself to quickly rid a problematic tooth and provide a new tooth replacement implant. It is not unusual for many practitioners to recommend tooth extraction with modest toothassociated ailments such as caries, need for endodontic therapy, or periodontal Sign In | My Tools | Contact Us | HELP involvement. There are many scenarios where patients are advised to get rid of the compromised tooth and get the “newer, better” implant. It has recently been advocated that practice patterns should change to retain more teeth given the excellent long-term track record of successful therapy for tooth preservation (Axelsson and Lindhe 1981; Lindhe and Pacey 2014). It is acknowledged that in many clinical situations, advanced diseases such as caries and periodontitis render teeth hopeless, requiring implant prosthetic solutions to rehabilitate patients. Most all dental implant systems are susceptible to peri-implant biological complications (Derks et al. 2015). These complications result in very difficult to treat options, including local mechanical therapy and antibiotics, resective surgery, regeneration, or, in a large number of cases, removal. The erroneous belief of implants yielding a better long-term prognosis has now clearly been rejected in several comparative studies and systematic reviews. Teeth even compromised because of periodontal disease or endodontic problems may have a longevity that surpasses by far that of the average implant (Carnevale et al. 1998; Hardt et al. 2002; Lang and Zitzmann 2012; Salvi et al. 2014; Klinge et al. 2015). This dialogue can be a call to action to revisit the long history of success of tooth maintenance to preserve the natural dentition without the rush to extract teeth and replace with implants. We do a disservice to our patients and ourselves without carefully weighing the advantages and disadvantages of such options in providing the optimal oral health care delivery to our patients. We have been trained to preserve teeth. Let us face the challenge. If we select an “early removal of compromised teeth” paradigm, the dental profession will lose most of its expertise in preserving a functional dentition for a lifetime.

See the January issue of the Journal of Dental Research 2016 - text below;

Journal of Dental Research jdr.sagepub.com doi: 10.1177/0022034515618942 JDR January 2016 vol. 95 no. 1 5-6 Are Dental Implants a Panacea or Should We Better Strive to Save Teeth? W.V. Giannobile1,2⇑ N.P. Lang3

Dental implants have become an important treatment for the replacement of teeth lost due to disease, injury, or congenital tooth agenesis (Adell et al. 1990). Over the past 30 years, the incorporation of dental implants into everyday clinical dental practice has resulted in major improvements in oral health of our patients through enhancements in function, esthetics, and phonetics. In this month’s issue of the Journal, we highlight new evidence on the biological complications of dental implants and the great challenges associated with predictable implant therapy. These adverse outcomes associated with implants have come to the forefront of discussion groups in periodontology, oral surgery, prosthodontics, and implant dentistry relating not only to prosthetic (technical) failure but also persistent infections surrounding implants. A recent systematic review based on a European consensus conference revealed that the prevalence of peri-implant mucositis and peri-implantitis ranges from 19% to 65% (Derks and Tomsai 2015). This month, results from one of the largest studies performed in Sweden show that peri-implantitis and peri-implant mucositis are common biological complications of implant therapy (Derks et al. 2016) that may jeopardize the longevity of reconstructions on implants. Tarnow (2016) comments on how far we have come in implant dentistry while at the same time recognizing the influence on success of implant placements by generalists, specialists, and different implant configurations/surfaces. One finds that reconstructive therapy of periimplantitis lesions is unpredictable as yet when compared to surgical resection, as evidenced by recent investigations and systematic reviews (Khoshkam et al. 2013; Carcuac et al. 2016; Jepsen et al. 2016). A trend affecting clinical practice over the past 2 decades has been the reduced emphasis to “save compromised teeth.” In fact, studies have demonstrated that those with less training in periodontology and implant dentistry generally apply reduced efforts in addressing tooth retention (Lang-Hua et al. 2014). It is noted that less trained individuals are often recommending tooth extraction versus retention. As such, many teeth are being condemned at early stages given the expediency that lends itself to quickly rid a problematic tooth and provide a new tooth replacement implant. It is not unusual for many practitioners to recommend tooth extraction with modest toothassociated ailments such as caries, need for endodontic therapy, or periodontal Sign In | My Tools | Contact Us | HELP involvement. There are many scenarios where patients are advised to get rid of the compromised tooth and get the “newer, better” implant. It has recently been advocated that practice patterns should change to retain more teeth given the excellent long-term track record of successful therapy for tooth preservation (Axelsson and Lindhe 1981; Lindhe and Pacey 2014). It is acknowledged that in many clinical situations, advanced diseases such as caries and periodontitis render teeth hopeless, requiring implant prosthetic solutions to rehabilitate patients. Most all dental implant systems are susceptible to peri-implant biological complications (Derks et al. 2015). These complications result in very difficult to treat options, including local mechanical therapy and antibiotics, resective surgery, regeneration, or, in a large number of cases, removal. The erroneous belief of implants yielding a better long-term prognosis has now clearly been rejected in several comparative studies and systematic reviews. Teeth even compromised because of periodontal disease or endodontic problems may have a longevity that surpasses by far that of the average implant (Carnevale et al. 1998; Hardt et al. 2002; Lang and Zitzmann 2012; Salvi et al. 2014; Klinge et al. 2015). This dialogue can be a call to action to revisit the long history of success of tooth maintenance to preserve the natural dentition without the rush to extract teeth and replace with implants. We do a disservice to our patients and ourselves without carefully weighing the advantages and disadvantages of such options in providing the optimal oral health care delivery to our patients. We have been trained to preserve teeth. Let us face the challenge. If we select an “early removal of compromised teeth” paradigm, the dental profession will lose most of its expertise in preserving a functional dentition for a lifetime.

Endo will be preferred rather than implant but based on the case it may vary.

hi, in my personal view our field is affected by marketing strategies of dental products manufacturers and their propaganda. you can not substitute endodontic treatment with implants, it can be alternative provided conditions favors like nonrestorability of tooth, absence of medical problems such as uncontrolled diabetes or certain other conditions which contraindicate surgery ( Eg: Radiation therapy). Moreover treatment plan should also respect patient's economic condition. well if they concern about success of endodontic treatment which if performed well have 85-95% success( provided a good coronal restoration is given) , i also have doubt about 100% success rate of implants.

Implants do not have 100% success...ten year data tends to show that success is possibly in the low 80%...why do you think we now see text books and articles published on dealing with implant failures...and how about those that are not in any report and the patient just has them taken out or the bone loss is so great they fall out. Remember, implants are evaluated as to survival not success or failure. 

Success and Failure are very relative terms which depends on its criteria. Success of endodontic treatment is more or less same as that of Implants. A point to be noted is that success of endodontics depends on so many factors like absence of clinical symptoms, radiographic evidence of healing of periapiical lesions etc. But with regard to Implants, the criteria are not very stringent. As mentioned by Prof James Gutmann, Implants are evaluated based on their survival rate. Even an implant with 4mm of radiographic bone loss is considered as satisfactory survival.

According to me, 'Root canal therapy Versus Dental Implant' is not an option to be given to the patients. Both treatment modalities are predictable and have long term evidences to support. But the case selection should be based purely on clinical judgement. Remember, Implants are not replacement for Natural Teeth. They are replacement for only MISSING TEETH.

Interesting discussion.

In my opinion, implant therapy is the ultimate solution. Nothing can replace natural teeth and we have to do everything possible to preserve it.

I am really happy for the discussion started with this question , I was encouraged by the  thoughts and Ideas that were loaded in the present  page , the sole of conservative and preventive dentistry is still valid, reminding us that we are health care providers not just repairing teeth , I hope that we can run a campaign to go back to the basic concepts of dentistry while at the same time use every tool that dentistry provided us with .

Remember we are dentist with the  conservative philosophy of  preserving  dentition not to scarify them , so please do not fool your self by being what is called now ironically (Smile designers ?????????)

please  save teeth by prevention and minimal restoration

THANK YOU ALL  

As practitioners we should have a clear conscience, without considering the economic benefits offered by other treatment strategies, we can ensure the highest quality treatment by honestly assessing the case difficulty, skills involved, inventory required and consider the case for treatment or referral for specialist consultation. Addressing patient needs should be the essential goal of treatment and improving the general health and well-being of the patient.

wonderful discussion.., Thanks to the one who initiated this...,

I feel implant is not an alternative to root canal treatment. They are the treatment options to replace missing tooth. So where does the question exist when the tooth is present. They can be considered as alternatives to various forms of prosthesis.

I agree with most what have been said above,,I would to stress on the point that both treatment modalities depends on case selection... It is not wise to compare survival rate of replacing missing tooth (implant) with success rate of eridecation of existing tooth periradicular pathology  (endodontic treatment).....furthermore the BEST IMPLANT IS THE SAVABLE, RESTORABLE NATURAL TOOTH..

Great point! Patient information should address the currentley accepted implant survival rate, as well the peri-implantitis prevalanece data.

We need a satisfactory Endodontic attempt on a restorable tooth first only on worst teeth provided a patient can afford one should look the alternatives!!