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Substantial Loss of the Tooth Structure and Vertical Root Fracture Are the Leading Causes of the Extraction of Endodontically Treated Teeth
TAKE-HOME MESSAGE
- This study, conducted at a dental school in the US, retrospectively assessed the reasons for the extraction of endodontically treated teeth followed by replacement with dental implant–based solutions. The mandibular first molar was the most commonly extracted and replaced tooth. The common reasons for extraction included recurrent caries owing to a defective restoration (26.6%), coronal fracture (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Notably, two experienced endodontists who reviewed the teeth extracted because of endodontic failures concluded that 61.7% of the teeth were indeed candidates for retreatment.
- Clinicians should be aware that a substantial loss of the tooth structure and vertical root fracture are the leading causes of the extraction of an endodontically treated tooth. The possibility of endodontic retreatment should be fully explored before extracting a tooth diagnosed with endodontic failure.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersINTRODUCTION
This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved.
METHODS
The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal-treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options.
RESULTS
Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment.
CONCLUSION
Substantial loss of tooth structure was the leading cause of extraction of root canal-treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment.
Additional Info
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Retrospective Assessment of Endodontically Treated Teeth Replaced by Dental Implants
J Endod 2024 Mar 01;50(3)310-315, DH Kim, PZ Tawil, JP Albouy, I DuqumFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The purpose of this retrospective study was to assess endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry between 2009 and 2014. First, the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants were evaluated. Second, the proportion of extracted endodontically treated teeth that, according to experienced UNC endodontists, could have been preserved was evaluated as well.
Of the 5229 teeth replaced by dental implants at UNC, 29.3% (n = 1564) received endodontic treatment. The leading reasons for the extraction of endodontically treated teeth that were subsequently replaced by dental implants were as follows: substantial loss of the tooth structure (ie, tooth fracture and teeth with defective restorations: 48.1%), vertical root fracture (20.9%), compromised periodontium (13.8%), and endodontic failure (2.4%). Interestingly, of the 2.4% of teeth lost due to endodontic failure, the endodontic evaluation team felt that 61.7% could have been candidates for endodontic retreatment.
Although the results of this retrospective study are of notice to the dental community at large, when interpreting the study’s specific results, it is important to remember that the study's data were acquired from a dental school setting (UNC). Depending on a clinician's practicing jurisdiction, different weighted reasonings for replacing endodontically treated teeth with dental implants may occur. Regardless, the practical results of this study are most telling, highlighting tooth structural reasons and not periodontal or endodontic reasons for the replacement of endodontically treated teeth with dental implants.