Review: Root canals just as effective as dental implants

May 14, 2007
But dentists emphasize saving natural teeth and patient-specific considerations.

CHICAGO — For patients torn between the best way to treat a compromised tooth, the choice just got clearer.

A recent systematic review comparing the two most common treatment options --root canals and dental implants--found virtually equal success, or survival rates, between both treatments. However, despite this similarity, the authors concluded that the priority should always be to preserve the natural tooth before extracting and replacing with an implant. Root canal treatment saves more than 17 million teeth a year.

The results of the treatment analysis were published by The International Journal of Oral and Maxillofacial Implants, the official publication of the Academy of Osseointegration, an organization committed to advancing dental implants.

The Academy also published a consensus statement developed by experts from several dental disciplines that supports the comparison's findings and stresses the importance of patient-specific considerations.

There are several notable differences between the two procedures. Dental implants require extracting the tooth followed by multiple surgeries to insert a metal post in the jaw and affix a porcelain crown to the post. These surgeries often can take three or more visits to complete, and can be timely and costly.

During root canal treatment, the source of tooth pain--inflamed pulp--is removed and the inside of the tooth is then cleaned, filled and sealed. Today, most root canals can be completed in one visit and are virtually painless.

Since the comparative analysis uncovered no significant differences in the success rates between the two options, the researchers emphasize that treatment decisions must be based on factors other than outcome, such as case complexity or the patient's individual health and preferences.

To assist dental professionals and their patients in determining the most appropriate treatment, the American Association of Endodontists, the national association representing root canal specialists, released a position statement on treatment planning when considering a root canal or dental implant.

According to Dr. Shepard S. Goldstein, AAE President and Framingham, Mass., endodontist, the position statement is meant to be used as a guide when deciding how to best treat a compromised tooth. For example, when a patient has diabetes, there are certain factors that the dental professional must consider when determining treatment.

"The recommended treatment must be safe, mindful of the patient's wishes, and should aim at preserving the natural tooth when possible," said Dr. Goldstein. "The AAE hopes that this guidance can help ensure that each patient receives the best treatment based on his or her unique case."

Dr. James Abbott, an endodontist from Santa Rosa, Calif., said many of his patients have had to choose between a root canal and a dental implant. "Most patients want to keep their natural tooth," says Dr. Abbott. "When I explain the details of both treatments and how the tooth can be saved with a root canal, the choice is simple."

The AAE position statement also is intended to assist dental professionals in evaluating the various risk factors and other implications associated with each of the treatment choices. Risk factors can include smoking, bone quality and estrogen level. For example, women with lower estrogen levels may encounter more treatment failures with implants.

According to the AAE statement, it is crucial that the patient's health and specific oral care needs be the most important considerations when weighing treatment options.

For more information, visit the AAE Web site at American Association of Endodontists.