Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: A systematic review

Torabinejad, Mahmoud; Anderson, Patricia; Bader, Jim; Brown, L. Jackson; Chen, Lie H.; Goodacre, Charles J.; Kattadiyil, Mathew T; Kutsenko, Diana; Lozada, Jaime; Patel, Rishi; Petersen, Floyd; Puterman, Israel; White, Shane N.

doi:10.1016/S0022-3913(07)60102-4

« Previous Next »Journal of Prosthetic Dentistry
Volume 98, Issue 4 , Pages 285-311, October 2007

Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: A systematic review

Mahmoud Torabinejad, DMD, MSD, PhD
- Professor of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif
Patricia Anderson, MILS
- Head Librarian, Dentistry Library, University of Michigan, Ann Arbor, Mich
Jim Bader, DDS, MPH
- Research Professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
L. Jackson Brown, DDS, PhD
- Associate Executive Director, Health Policy Resources Center, American Dental Association, Chicago, Ill
Lie H. Chen, MPH
- Statistical Programmer, Health Research Consulting Group, School of Public Health, Loma Linda University, Loma Linda, Calif
Charles J. Goodacre, DDS, MSD
- Professor of Restorative Dentistry and Dean, School of Dentistry, Loma Linda University, Loma Linda, Calif
Mathew T Kattadiyil, DDS, MDS, MS
- Associate Professor of Restorative Dentistry and Interim Director, Advanced Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif
Diana Kutsenko, DMD
- Resident, Postgraduate Endodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif
Jaime Lozada, DDS
- Professor and Graduate Program Director of Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, Calif
Rishi Patel, BDS
- Resident, Advanced Education Program in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif
Floyd Petersen, MPH
- Assistant Professor, Health Research Consulting Group, Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, Calif
Israel Puterman, DMD
- Resident, Postgraduate Periodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif
Shane N. White, BDentSc, MS, MA, PhD
- Professor, University of California Los Angeles School of Dentistry, Los Angeles, Calif
- Corresponding author: Dr Shane N. White UCLA School of Dentistry 10833 LeConte Ave CHS 23-010 Los Angeles, CA 90095-1668 Fax: 310-206-3644

Statement of problem

Dentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)?

Purpose

The purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement.

Material and methods

Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations.

Results

The 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs.

Conclusions

Lack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.