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Treating Our Patients Using Endodontic and Implant Restorations

Treating Our Patients Using Endodontic and Implant Restorations

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Treating Our Patients Using Endodontic and Implant Restorations

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  1. Treating Our Patients Using Endodontic and Implant Restorations PPAC

  2. Treatment Numbers • Endodontic and implant restorations are performed daily by dentists and specialists • For endodontic treatment, estimates for the year 2000 were 30 million endodontic procedures annually (ADA) • Estimated number of patients receiving endosseous implants • 1996 - 300,000-428,000 annually, • 2000 - 910,000 annually • future annual growth rate - 18.6% (Millenium Research Group)

  3. Treatment Numbers 40% increase annually 1997-2007

  4. Treatment Considerations • “Treatment planning for the future: Endodontics, fixed partial dentures – or implants?”

  5. Treatment Considerations • “The success rate of non-surgical root canal treatment is unclear within the endodontic literature.” • “…(endodontics) in general practice, the success rate can be 64% to 75%.” • “Endodontic therapy may extend the life of the tooth but very little is known on the extent of tooth longevity.”

  6. Implants vs. Endodontics • The Academy of Osseointegration’s 2006 workshop on the state of the science of implant dentistry entrusted Iqbal and Kim to systematically “review clinical studies of the survival of single-tooth implants and endodontically treated and restored teeth and to compare the results.” • Iqbal MK, Kim S, 2007

  7. Implants vs. Endodontics • Furthermore, in response to an ADA Foundation request for proposals Torabinejad, et al, conducted a systematic review of the clinical, psychosocial, and economic outcomes of endodontics, implants and FPDs. • Torabinejad, et al, 2007

  8. Implants vs. Endodontics • Success criteria • Problem areas • Who’s treating • Publication bias • Modern advances

  9. Apples vs. Oranges • Success criteria • Problem areas • Who’s treating • Publication bias • Modern advances

  10. Implants vs. Endodontics • Success criteria • Problem areas • Who’s treating • Publication bias • Modern advances

  11. Success Criteria Endodontic Criteria • 1956, Strindberg proposes stringent radiographic criteria • Strindberg LZ, 1956

  12. Success Criteria Endodontic Criteria • 1956, Strindberg proposes radiographic criteria • Beginning in 1966 and since, many authors suggest radiographic criteria is ill advised • Bender IB, Seltzer S and Soltanoff W, 1966 • Van Nieuwenhuysen JP, et al, 1994 • Fristad I, et al, 2004 • Gutmann JL, 1992 • Seltzer S, 1988

  13. Success Criteria Endodontic Criteria • 1956, Strindberg proposes radiographic criteria • Beginning in 1966 and since, many authors suggest radiographic criteria is ill advised • However, some studies still use Strindberg’s dated criteria. • Allen R, Newton C and Brown C, 1991 • Sundqvist G, et al, 1998 • Sjogren U, et al, 1990 • Farzaneh M, Abitbol S and Friedman S, 2004

  14. Success Criteria Endodontic Criteria • 1956, Strindberg proposes radiographic criteria • Beginning in 1966 and since, many authors suggest radiographic criteria is ill advised • However, some studies still use Strindberg’s dated criteria. • Fristad and colleagues showed the potential for late radiographic healing. • Fristad, Molven and Halse, 2004

  15. Success Criteria

  16. Success Criteria

  17. Endodontic Success Criteria 3-year recall

  18. Endodontic Success Criteria

  19. Endodontic Success Criteria

  20. Endodontic Success Criteria 12-month recall

  21. Success Criteria • 1956, Strindberg proposes radiographic criteria • Beginning in 1966 and since, many authors suggest radiographic criteria is ill advised • However, some studies still use Strindberg’s dated criteria. • Fristad and colleagues showed the potential for late radiographic healing. • Success or Survival? • Iqbal MK, Kim S, 2007

  22. Success Criteria • Success or Survival? • The definition of “success” for dental implant studies is often implant survival • Unlike implants and FPDs, RCTs aim to cure existing disease • Weiger, et al, 1998

  23. Success Criteria • Success or Survival? • Unlike implants and FPDs, RCTs aim to cure existing disease • Thus, RCT studies measure both the healing of existing disease and the occurrence of new disease. • Torabinejad, et al, 2007

  24. Success Criteria • Success or Survival? • It has been suggested that implant success criteria are not routinely applied in much of the implant outcomes literature • Salinas and Eckert, 2007

  25. Success Criteria • Success or Survival? • “In essence, the use of lenient success criteria in implant studies may translate to higher success rates, while stringent criteria employed in root canal prognostic studies may lead to lower success rates.” • Watson, et al, 1999 • Johnson, et al, 2000 • Wennstrom, et al, 2005

  26. Success Criteria In order to establish comparable comparisons, it is critical that the same outcome measure is used to assess both endodontic and implant procedures.

  27. Success Criteria • In order to establish comparable comparisons, it is critical that the same outcome measure is used to assess both endodontic and implant procedures • Due to these differences in meanings of success, it is probable survival rates “will permit less biased, albeit less informative, comparisons.” • Doyle, et al, 2006 • Eckert and Wollan, 1998 • Creugers, et al, 2000 • Torabinejad, et al, 2007

  28. Success Criteria • The Academy of Osseointegration’s 2006 workshop on the state of the science of implant dentistry entrusted Iqbal and Kim to systematically “review clinical studies of the survival of single-tooth implants and endodontically treatedand restored teeth and to compare the results.” • Iqbal MK, Kim S, 2007

  29. Success Criteria • Success or Survival? • Iqbal MK, Kim S, 2007

  30. Success Criteria - Implants • Two 3.75 x 18 implants were placed on #9, 10 sites • Implants appear osseointegrated

  31. Success Criteria - Implants Initial visit pt presented with provisional restorations Esthetics case referred to Dr. Debra Johnson

  32. Implants vs. Endodontics • Success criteria • Problem areas • Who’s treating • Publication bias • Modern advances

  33. Restorative Impact Lazarski et al examined over 110,000 endodontic cases, and found teeth that were not restored were significantly more likely (>4 X) to undergo extraction. Lazarski et al 2001

  34. Restorative Impact • Lazarski et al examined over 110,000 endodontic cases, and found teeth that were not restored were significantly more likely (>4 X) to undergo extraction. • The restoration of an endodontically treated tooth is considered a major determinant of its survival. • Vire DE, 1991 • Siqueira JF, 2001 • Hoen MM, Pink FE, 2002 • Salehrabi R, Rotstein I, 2004 • Aquilino SA, Caplan DJ, 2002 • Sorensen JA, Martinoff JT, 1985

  35. Restorative Impact • The Academy of Osseointegration’s 2006 workshop on the state of the science of implant dentistry entrusted Iqbal and Kim to systematically “review clinical studies of the survival of single-tooth implants and endodontically treated and restored teeth and to compare the results.” • Iqbal MK, Kim S, 2007

  36. Restorative Impact

  37. Restorative Impact

  38. Restorative Impact

  39. Restorative Impact 22-month recall

  40. Restorative Impact • The restoration of an endodontically treated tooth is considered a major determinant of its survival. • More prosthetic complications with implants. • Goodacre CJ, et al, 2003 • Iqbal MK, Kim S, 2007 • Doyle et al 2006

  41. Bone Loss Around Implants • With implant placement, 1 mm of bone is loss during the first year of placement, with an additional 0.1mm annually. • Can vary with implant type/material

  42. Bone Loss Around Implants Bone Loss (mm) n=455 Error bars = S.E.M.

  43. Cost to Patient Analysis of 2005 insurance data concluded that restored single-tooth implants cost 75-90% more than similarly restored endodontic-treated teeth

  44. Cost to Patient • Analysis of 2005 insurance data concluded that restored single-tooth implants cost 75-90% more than similarly restored endodontic-treated teeth • Post-treatment problems can increase this cost difference

  45. Cost to Patient 130% Increase Average Price ($$)

  46. Implants vs. Endodontics • Success criteria • Problem areas • Who’s treating • Publication bias • Modern advances

  47. Who’s Treating? • Historically, implants placed by specialists, while many endodontic studies were conducted on patients treated by dental students. • Aquilino SA, Caplan DJ, 2002 • Bergman B, et al, 1989 • Dammaschke T, et al, 2003 • Lynch CD, et al, 2004 • Mentink AG, et al, 1993

  48. Who’s Treating? • Of 13,047 identified studies, 147 articles from the endo, prosth and implant literature were systematically reviewed. • Torabinejad, et al, 2007

  49. Who’s Treating? • Of 13,047 identified studies, 147 articles from the endo, prosth and implant literature were systematically reviewed. • Torabinejad, et al, 2007 GPs or Specialists Students Implant 0%87% Prostho 29% 35% Endo 63%29%

  50. Who’s Treating?