There remains huge variability in decision-making when it comes to whether a compromised tooth requiring endodontic treatment should be saved, or extracted and replaced with an implant. Both internal and external biases, as well as inconsistent data from clinical studies, further complicate this frequent clinical conundrum. This paper presents tangible outcomes for both root-filled teeth and dental implants, together with comparative research to help clinicians better understand the available data. It is hoped that we can also highlight the key considerations when treatment planning for both root-filled teeth and dental implants. Both treatment modalities have excellent survival rates, but at the same time, neither is a panacea. Holistic and thoughtful consideration is required to help guide patients to make well-informed choices regarding their treatment.

  • Both root-filled teeth and dental implants have excellent success and survival rates. Clinicians should appreciate the difference between success and survival when evaluating the available literature.
  • A holistic treatment planning approach is required when decision-making between retaining a compromised root-filled tooth and replacing it with a dental implant.
  • Clinicians should be aware of short-, medium- and long-term complications for both root-filled teeth and dental implants. The role of occlusion appears critical to the survival of both treatment modalities.
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