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Treating Our Patients Using Endodontic and Implant Restorations

Treating Our Patients Using Endodontic and Implant Restorations. 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)

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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

  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?

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