Skip to main content
SpringerLink
Log in

From Tooth Retention Through Root Canal Treatment to Extraction and Replacement

  • Chapter
  • First Online:
Endodontic Prognosis

Abstract

Initial nonsurgical root canal treatment (NSRCT) is highly successful, is appreciated by patients, relieves pain, and is cost-effective. Results from systematic reviews and studies with very large sample sizes show very high tooth survival rates following NSRCT. Very few patient-associated factors decrease the prognosis for healing after NSRCT. The vast majority of cases will heal following initial NSRCT; the small minority that do not heal are generally best addressed by nonsurgical retreatment. Nonsurgical retreatment is effective and conservative, addressing bacteria remaining within the root canal system. Healing rates increase over time following nonsurgical retreatment. The very small proportion of cases that do not heal after nonsurgical retreatment are best addressed by modern apical microsurgery. Additional case-specific surgical options should be considered before extraction. Intentional replantation remains a viable alternative to extraction. Autotransplantation has a place, particularly in growing patients with an appropriate donor tooth. Root amputation is effective when disease is localized to a single root where adequate remaining tooth structure and periodontal support will remain. Valid reasons to extract and replace an unhealed NSRCT tooth include lack of remaining tooth structure, high caries risk, or high periodontal risk. Not all extracted teeth need to be replaced, but when replacement is indicated, the single-tooth implant is preferred. Single-tooth implants have higher survival rates, but the natural state has intrinsic value. Comprehensive case assessment, evaluation of all endodontic options, and risk assessment for caries and periodontal disease are always necessary when choosing the optimal treatment for a patient when initial root canal treatment has failed to heal.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. White SN. Complementary therapies, not competing treatments. Int J Prosthodont. 2008;21:10.

    PubMed  Google Scholar 

  2. Iqbal MK, Kim S. For teeth requiring endodontic therapy, what are the differences in the outcomes of restored endodontically treated teeth compared to implant-supported restorations? Int J Oral Maxillofac Implants. 2007;221(suppl):96–116.

    Google Scholar 

  3. Torabinejad M, Anderson P, Bader J, et al. The outcomes of endodontic treatment, single implant, fixed partial denture and no tooth replacement: a systematic review. J Prosthet Dent. 2007;98:285–311.

    Article  PubMed  Google Scholar 

  4. Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J. 2010;43:171–89.

    Article  PubMed  Google Scholar 

  5. Lazarski MP, Walker 3rd WA, Flores CM, et al. Epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients. J Endod. 2001;27:791.

    Article  PubMed  Google Scholar 

  6. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod. 2004;30:846–50.

    Article  PubMed  Google Scholar 

  7. Chen S, Chueh L, Hsiao CK, Tsai M, Ho S, Chiang C. An epidemiologic study of tooth retention after nonsurgical endodontic treatment in a large population in Taiwan. J Endod. 2007;33:226–9.

    Article  PubMed  Google Scholar 

  8. Raedel M, Hartmann A, Bohm S, Walter MH. Three-year outcomes of root canal treatment: mining an insurance database. J Dent. 2015;43:412–7.

    Article  PubMed  Google Scholar 

  9. Gilbert GH, Tilashalski KR, Litaker MS, et al. Outcomes of root canal treatment in Dental Practice-Based Research Network practices. Gen Dent. 2010;58:28–36.

    PubMed  PubMed Central  Google Scholar 

  10. Bernstein SD, Horowitz AJ, Man M, et al. Outcomes of endodontic therapy in general practice: a study by the Practitioners Engaged in Applied Research and Learning Network. J Am Dent Assoc. 2012;143:478–87.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vire DE. Failure of endodontically treated teeth: classification and evaluation. J Endod. 1991;17:338–42.

    Article  PubMed  Google Scholar 

  12. Fuss Z, Lustig J, Tamse A. Prevalence of vertical root fractures in extracted endodontically treated teeth. Int Endod J. 1999;32:283–6.

    Article  PubMed  Google Scholar 

  13. Doyle SL, Hodges JS, Pesun IJ, Law AS, Bowles WR. Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants. J Endod. 2006;32:822–7.

    Article  PubMed  Google Scholar 

  14. Chen S-C, Chueh L, Hsiao CK, et al. First untoward events and reasons for tooth extraction after nonsurgical endodontic treatment in Taiwan. J Endod. 2008;34:671–4.

    Article  PubMed  Google Scholar 

  15. Wang C, Chueh L, Chen S, Feng Y, Hsiao CK, Chiang C. Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod. 2011;37:1–5.

    Article  PubMed  Google Scholar 

  16. Lee AH, Cheung GS, Wong MC. Long-term outcome of primary non-surgical root canal treatment. Clin Oral Investig. 2012;16:1607–17.

    Article  PubMed  Google Scholar 

  17. Pak JG, Fayazi S, White SN. Prevalence of periapical radiolucency and root canal treatment: a systematic review of cross-sectional studies. J Endod. 2012;38:1170–6.

    Article  PubMed  Google Scholar 

  18. Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod. 2011;37:429–38.

    Article  PubMed  Google Scholar 

  19. Law AS, Nixdorf DR, Rabinowitz I, et al. Root canal therapy reduces multiple dimensions of pain: a national dental practice-based research network study. J Endod. 2014;40:1738–45.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Torabinejad M, Salha W, Lozada JL, Hung YL, Garbacea A. Degree of patient pain, complications, and satisfaction after root canal treatment or a single implant: a preliminary prospective investigation. J Endod. 2014;40:1940–5.

    Article  PubMed  Google Scholar 

  21. Lobb WK, Zakariasen KL, McGrath PJ. Endodontic treatment outcomes: do patients perceive problems? J Am Dent Assoc. 1996;127:597–600.

    Article  PubMed  Google Scholar 

  22. Dugas NN, Lawrence HP, Teplitsky P, Friedman S. Quality of life and satisfaction outcomes of endodontic treatment. J Endod. 2002;28:819–27.

    Article  PubMed  Google Scholar 

  23. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications in fixed prosthodontics. J Prosthet Dent. 2003;90:31–41.

    Article  PubMed  Google Scholar 

  24. Balevi B, Shepperd S. The management of an endodontically abscessed tooth: patient health state utility, decision-tree and economic analysis. BMC Oral Health. 2007;7:17.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kim SG, Solomon C. Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives. J Endod. 2011;37:321.

    Article  PubMed  Google Scholar 

  26. Hamedy R, Shakiba B, Fayazi S, Pak JG, White SN. Patient-centered endodontic outcomes: a narrative review. Iran Endod J. 2013;8:197–204.

    PubMed  PubMed Central  Google Scholar 

  27. Strindberg LL. The dependence of the results of pulp therapy on certain factors. Acta Odontol Scand. 1956;14:175.

    Google Scholar 

  28. Ørstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986;2:20–34.

    Article  PubMed  Google Scholar 

  29. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature—part 1. Effects of study characteristics on probability of success. Int Endod J. 2007;40:921–39.

    Article  PubMed  Google Scholar 

  30. Storms J. Factors that influence the success of endodontic treatment. J Can Dent Assoc. 1969;35:83–97.

    PubMed  Google Scholar 

  31. Fouad AF, Burleson J. The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record. J Am Dent Assoc. 2003;134:43.

    Article  PubMed  Google Scholar 

  32. Kojima K, Inamoto K, Nagamatsu K, et al. Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:95–9.

    Article  PubMed  Google Scholar 

  33. Quesnell BT, Alves M, Hawkinson RW, Johnson BR, Wenckus CS, BeGole EA. The effect of human immunodeficiency virus on endodontic treatment outcome. J Endod. 2005;31:633–6.

    Article  PubMed  Google Scholar 

  34. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J. 2011;44:610–25.

    Article  PubMed  Google Scholar 

  35. Hamedy R, Shakiba B, Pak JG, Barbizam JV, Ogawa RS, White SN. Prevalence of root canal treatment and periapical radiolucency in elders: a systematic review. Gerodontology. 2014;33:116–27.

    Article  PubMed  Google Scholar 

  36. Britto LR, Katz J, Guelmann M, Heft M. Periradicular radiographic assessment in diabetic and control individuals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:449–52.

    Article  PubMed  Google Scholar 

  37. Sjögren U, Hägglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16:498–504.

    Article  PubMed  Google Scholar 

  38. Friedman S. Success and failure of initial endodontic therapy. Ont Dent. 1997;74:35–8.

    PubMed  Google Scholar 

  39. Chugal NM, Clive JM, Spangberg LS. A prognostic model for assessment of the outcome of endodontic treatment: effect of biologic and diagnostic variables. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:342–52.

    Article  PubMed  Google Scholar 

  40. Stoll R, Betke K, Stachniss V. The influence of different factors on the survival of root canal fillings: a 10-year retrospective study. J Endod. 2005;31:783–90.

    Article  PubMed  Google Scholar 

  41. Tavares PB, Bonte E, Boukpessi T, Siqueira Jr JF, Lasfargues JJ. Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: influence of the quality of root canal fillings and coronal restorations. J Endod. 2009;35:810–3.

    Article  PubMed  Google Scholar 

  42. Pirani C, Chersoni S, Montebugnoli L, Prati C. Long-term outcome of non-surgical root canal treatment: a retrospective analysis. Odontology. 2014;103:185–93.

    Google Scholar 

  43. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979;5:83–90.

    Article  PubMed  Google Scholar 

  44. Matsumoto T, Nagai T, Ida K, Ito M, Kawai Y, Horiba N, Sato R, Nakamura H. Factors affecting successful prognosis of root canal treatment. J Endod. 1987;13:239–42.

    Article  PubMed  Google Scholar 

  45. Torabinejad M, Kutsenko D, Machnick TK, et al. Levels of evidence for the outcome of nonsurgical endodontic treatment. J Endod. 2005;31:637–46.

    Article  PubMed  Google Scholar 

  46. Chugal NM, Clive JM, Spangberg LS. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:81–90.

    Article  PubMed  Google Scholar 

  47. Torabinejad M, White SN. Endodontic treatment options after unsuccessful initial root canal treatment: alternatives to single-tooth implants. J Am Dent Assoc 2016;147:214–20.

    Google Scholar 

  48. Paik S, Sechrist C, Torabinejad M. Levels of evidence for the outcome of endodontic retreatment. J Endod. 2004;30:745–50.

    Article  PubMed  Google Scholar 

  49. Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study. Phases I and II: orthograde retreatment. J Endod. 2004;30:627–33.

    Article  PubMed  Google Scholar 

  50. Bergenholtz G, Lekholm U, Milthon R, et al. Retreatment of endodontic fillings. Scand J Dent Res. 1979;87:217–24.

    PubMed  Google Scholar 

  51. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009;35:930–7.

    Article  PubMed  Google Scholar 

  52. Mead C, Javidan-Nejad S, Mego M, et al. Levels of evidence for the outcome of endodontic surgery. J Endod. 2005;31:1924.

    Article  Google Scholar 

  53. Rubinstein RA, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod. 2002;28:378–83.

    Article  PubMed  Google Scholar 

  54. Setzer FC, Kohli MR, Shah SB, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature—part 2: comparison of endodontic microsurgical techniques with and without use of higher magnification. J Endod. 2010;36:1757–65.

    Article  PubMed  Google Scholar 

  55. Torabinejad M, Landaez M, Milan M, et al. Tooth retention through endodontic microsurgery or tooth replacement using single implants: a systematic review of treatment outcomes. J Endod. 2015;41:1–10.

    Article  PubMed  Google Scholar 

  56. Torabinejad M, Dinsbach N, Turman M, et al. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review of treatment outcomes. J Endod. 2015;41:992–8.

    Article  PubMed  Google Scholar 

  57. Andreasen JO, Paulsen HU, Yu Z, et al. A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation. Eur J Orthod. 1990;12:14–24.

    Article  PubMed  Google Scholar 

  58. Tsukiboshi M. Autogenous tooth transplantation: a reevaluation. Int J Periodontics Restorative Dent. 1993;13:120–49.

    PubMed  Google Scholar 

  59. Akiyama Y, Fukuda H, Hashimoto K. A clinical and radiographic study of 25 autotransplanted third molars. J Oral Rehabil. 1998;25:640–4.

    Article  PubMed  Google Scholar 

  60. Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years. J Periodontol. 2001;72:1113–23.

    Article  PubMed  Google Scholar 

  61. Mannocci F, Bertelli E, Sherriff M, Watson TF, Ford TR. Three-year clinical comparison of survival of endodontically treated teeth restored with either full cast coverage or with direct composite restoration. J Prosthet Dent. 2002;88:297–301.

    Article  PubMed  Google Scholar 

  62. Creugers NH, Mentink AG, Fokkinga WA, Kreulen CM. 5-year follow-up of a prospective clinical study on various types of core restorations. Int J Prosthodont. 2005;18:34–9.

    PubMed  Google Scholar 

  63. Creugers NH, Kreulen CM, Fokkinga WA, Mentink AG. A 5-year prospective clinical study on core restorations without covering crowns. Int J Prosthodont. 2005;18:40–1.

    PubMed  Google Scholar 

  64. Grandini S, Goracci C, Tay FR, Grandini R, Ferrari M. Clinical evaluation of the use of fiber posts and direct resin restorations for endodontically treated teeth. Int J Prosthodont. 2005;18:399–404.

    PubMed  Google Scholar 

  65. Nagasiri R, Chitmongkolsuk S. Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosthet Dent. 2005;93:164–70.

    Article  PubMed  Google Scholar 

  66. Bolla M, Muller Bolla M, Borg C, Lupi-Pegurier L, Laplanche O, Leforestier E. Root canal posts for the restoration of root filled teeth. Cochrane Database Syst Rev. 2007;1, CD004623.

    Google Scholar 

  67. Ferrari M, Cagidiaco MC, Goracci C, Vichi A, Mason PN, Radovic I, Tay F. Long-term retrospective study of the clinical performance of fiber posts. Am J Dent. 2007;20:287–91.

    PubMed  Google Scholar 

  68. Ferrari M, Cagidiaco MC, Grandini S, De Sanctis M, Goracci C. Post placement affects survival of endodontically treated premolars. J Dent Res. 2007;86:729–34.

    Article  PubMed  Google Scholar 

  69. Bitter K, Noetzel J, Stamm O, Vaudt J, Meyer Lueckel H, Neumann K, Kielbassa AM. Randomized clinical trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months. J Endod. 2009;35:1477–82.

    Article  PubMed  Google Scholar 

  70. Signore A, Benedicenti S, Kaitsas V, Barone M, Angiero F, Ravera G. Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage. J Dent. 2009;37:115–21.

    Article  PubMed  Google Scholar 

  71. Signore A, Kaitsas V, Ravera G, Angiero F, Benedicenti S. Clinical evaluation of an oval-shaped prefabricated glass fiber post in endodontically treated premolars presenting an oval root canal cross-section: a retrospective cohort study. Int J Prosthodont. 2011;24:255–63.

    PubMed  Google Scholar 

  72. Mancebo JC, Jiménez-Castellanos E, Cañadas D. Effect of tooth type and ferrule on the survival of pulpless teeth restored with fiber posts: a 3-year clinical study. Am J Dent. 2010;23:351–6.

    PubMed  Google Scholar 

  73. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, Polimeni A, Goracci C. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res. 2012;91(S 7):72–8.

    Article  Google Scholar 

  74. Naumann M, Koelpin M, Beuer F, Meyer Lueckel H. 10-year survival evaluation for glass-fiber-supported postendodontic restoration: a prospective observational clinical study. J Endod. 2012;38:432–5.

    Article  PubMed  Google Scholar 

  75. Dammaschke T, Nykiel K, Sagheri D, Schäfer E. Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: a retrospective study. Aust Dent J. 2013;39:48–56.

    Google Scholar 

  76. Hurlbutt M, Young DA. A best practices approach to caries management. J Evid Based Dent Pract. 2014;14(Suppl):77–86.

    Article  PubMed  Google Scholar 

  77. Kutsch VK. Dental caries: an updated medical model of risk assessment. J Prosthet Dent. 2014;11:280–5.

    Article  Google Scholar 

  78. Tellez M, Gomez J, Pretty I, Ellwood R, Ismail AI. Evidence on existing caries risk assessment systems: are they predictive of future caries? Community Dent Oral Epidemiol. 2013;41:67–78.

    Article  PubMed  Google Scholar 

  79. Lang NP, Suvan JE, Tonetti MS. Risk factor assessment tools for the prevention of periodontitis progression a systematic review. J Clin Periodontol. 2015;42 Suppl 16:S59–70.

    Article  PubMed  Google Scholar 

  80. McGuire MK, Nunn ME. Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol. 1996;67:666–74.

    Article  PubMed  Google Scholar 

  81. Torabinejad M, Goodacre CJ. Endodontic or dental implant therapy: the factors affecting treatment planning. J Am Dent Assoc. 2006;137:973–7.

    Article  PubMed  Google Scholar 

  82. White SN, Miklus VG, Potter KS, Cho J, Ngan AY. Endodontics and implants, a catalog of therapeutic contrasts. J Evid Based Dent Pract. 2006;6:101–9.

    Article  PubMed  Google Scholar 

  83. Zitzmann NU, Krastl G, Hecker H, Walter C, Waltimo T, Weiger R. Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth. J Prosthet Dent. 2010;104:80–91.

    Article  PubMed  Google Scholar 

  84. Salinas TJ, Eckert SE. In patients requiring single-tooth replacement, what are the outcomes of implant- as compared to tooth-supported restorations? Int J Oral Maxillofac Implants. 2007;22(Suppl):71–95.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCLA School of Dentistry, Los Angeles, CA, USA

    Shane N. White

  2. Advanced Specialty Education Program in Endodontics, Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA

    Mahmoud Torabinejad

Authors
  1. Shane N. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahmoud Torabinejad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shane N. White .

Editor information

Editors and Affiliations

  1. Section of Endodontics, UCLA School of Dentistry, Los Angeles, California, USA

    Nadia Chugal

  2. Dept of Endodontics, NYU College of Dentistry, New York, New York, USA

    Louis M Lin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

White, S.N., Torabinejad, M. (2017). From Tooth Retention Through Root Canal Treatment to Extraction and Replacement. In: Chugal, N., Lin, L. (eds) Endodontic Prognosis. Springer, Cham. https://doi.org/10.1007/978-3-319-42412-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42412-5_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42410-1

  • Online ISBN: 978-3-319-42412-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation